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. 2018 Nov;39(11):1330-1333.
doi: 10.1017/ice.2018.225. Epub 2018 Sep 18.

Clostridium difficile colonization among patients with clinically significant diarrhea and no identifiable cause of diarrhea

Erik R Dubberke  1 , Kimberly A Reske  1 , Tiffany Hink  1 , Jennie H Kwon  1 , Candice Cass  1 , Jahnavi Bongu  1 , Carey-Ann D Burnham  2 , Jeffrey P Henderson  1
Affiliations

Clostridium difficile colonization among patients with clinically significant diarrhea and no identifiable cause of diarrhea

Erik R Dubberke et al. Infect Control Hosp Epidemiol. 2018 Nov.

Abstract

Objective: To determine the prevalence of Clostridium difficile colonization among patients who meet the 2017 IDSA/SHEA C. difficile infection (CDI) Clinical Guideline Update criteria for the preferred patient population for C. difficile testing.

Design: Retrospective cohort.

Setting: Tertiary-care hospital in St. Louis, Missouri.PatientsPatients whose diarrheal stool samples were submitted to the hospital's clinical microbiology laboratory for C. difficile testing (toxin EIA) from August 2014 to September 2016.InterventionsElectronic and manual chart review were used to determine whether patients tested for C. difficile toxin had clinically significant diarrhea and/or any alternate cause for diarrhea. Toxigenic C. difficile culture was performed on all stool specimens from patients with clinically significant diarrhea and no known alternate cause for their diarrhea.

Results: A total of 8,931 patients with stool specimens submitted were evaluated: 570 stool specimens were EIA positive (+) and 8,361 stool specimens were EIA negative (-). Among the EIA+stool specimens, 107 (19% of total) were deemed eligible for culture. Among the EIA- stool specimens, 515 (6%) were eligible for culture. One EIA+stool specimen (1%) was toxigenic culture negative. Among the EIA- stool specimens that underwent culture, toxigenic C. difficile was isolated from 63 (12%).

Conclusions: Most patients tested for C. difficile do not have clinically significant diarrhea and/or potential alternate causes for diarrhea. The prevalence of toxigenic C. difficile colonization among EIA- patients who met the IDSA/SHEA CDI guideline criteria for preferred patient population for C. difficile testing was 12%.

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Conflict of interest statement

Conflicts of interest.

Outside the submitted work, E.R.D. reports grants from Rebiotix; grants and personal fees from Pfizer and Merck; and personal fees from Valneva, Rebiotix, Achaogen, Biofire, Abbott, and Synthetic Biologics. Outside the submitted work, C.D.B. reports grants from bioMerieux, Cepheid, and Luminex; grants and personal fees from Accelerate Diagnostics; and personal fees from BioRad and the Journal of Clinical Microbiology. All other authors report no conflicts of interest.

Figures

Fig. 1.
Fig. 1.
Results of screening and C. difficile toxigenic culture.
See this image and copyright information in PMC

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