A Clostridium difficile infection 鈥渋ntervention鈥? Change in toxin assay results in fewer C difficile infection cases without changes in patient outcomes

详细信息	查看全文 | 推荐本文 |

• 作者：Zhuolin Han ; MD ; MS^a ; ^{juliazhan@hotmail.com} ; Kathleen M. McMullen ; MPH ; CIC^b ; Anthony J. Russo ; MPH^b ; Susan M. Copper ; MT(ASCP)^b ; David K. Warren ; MD ; MPH^a ; Erik R. Dubberke ; MD ; MSPH^a
• 关键词：Toxin enzyme immunoassay ; Metronidazole ; Vancomycin
• 刊名：American Journal of Infection Control
• 出版年：2012
• 期刊代码：9_01966553
• 类别：med
• 出版时间：May, 2012
• 卷：40
• 期：4
• 页码：349-353
• 文件大小：284 K

摘要

| Figures/TablesFigures/Tables | ReferencesReferencescoding="UTF-8"?>

class="h4">Background

Clostridium difficile infection (CDI) is most commonly diagnosed using toxin enzyme immunoassays (EIAs). A sudden decrease in CDI incidence was noted after a change in the EIA used at Barnes-Jewish Hospital in St Louis. The objective of this study was to determine whether the decreased CDI incidence related to the change in EIA resulted in adverse patient outcomes.

class="h4">Methods

Electronic hospital databases were used to collect data on demographics, outcomes, and treatment of inpatients who had a C difficile toxin assay performed between January 4, 2009, and April 3, 2009 (period A, preassay change) and between May 21, 2009, and August 17, 2009 (period B, postassay change).

class="h4">Results

Assays were positive in 240 of 1,221 patients (19.7%) during period A and in 106 of 1160 patients (9.1%) during period B (P聽< .01). There was no difference in mortality or discharge to hospice between the 2 periods (10.3%vs 10.1%; P聽= .90). Patients tested in period B were less likely to receive metronidazole or oral vancomycin (P < .01).

class="h4">Conclusions

The new EIA resulted in fewer positive tests and reduced anti-CDI therapy. There was no difference in mortality between the 2 periods, suggesting that the decreased incidence was due to increased assay specificity, not decreased sensitivity.