Document Detail

A Clostridium difficile infection "intervention": change in toxin assay results in fewer C difficile infection cases without changes in patient outcomes.
MedLine Citation:
PMID:  21794950     Owner:  NLM     Status:  MEDLINE    
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.
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).
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 < .01). There was no difference in mortality or discharge to hospice between the 2 periods (10.3% vs 10.1%; P = .90). Patients tested in period B were less likely to receive metronidazole or oral vancomycin (P < .01).
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.
Zhuolin Han; Kathleen M McMullen; Anthony J Russo; Susan M Copper; David K Warren; Erik R Dubberke
Publication Detail:
Type:  Evaluation Studies; Journal Article; Research Support, N.I.H., Extramural; Research Support, U.S. Gov't, P.H.S.     Date:  2011-07-27
Journal Detail:
Title:  American journal of infection control     Volume:  40     ISSN:  1527-3296     ISO Abbreviation:  Am J Infect Control     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-04-30     Completed Date:  2012-08-15     Revised Date:  2014-09-09    
Medline Journal Info:
Nlm Unique ID:  8004854     Medline TA:  Am J Infect Control     Country:  United States    
Other Details:
Languages:  eng     Pagination:  349-53     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.
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MeSH Terms
Aged, 80 and over
Bacterial Toxins / analysis*
Clinical Laboratory Techniques / methods*
Clostridium Infections / diagnosis*,  drug therapy,  epidemiology*,  mortality
Clostridium difficile / isolation & purification*
Cohort Studies
Immunoenzyme Techniques / methods
Middle Aged
Missouri / epidemiology
Sensitivity and Specificity
Survival Analysis
Treatment Outcome
Grant Support
5U01C1000333//PHS HHS; K23 AI065806/AI/NIAID NIH HHS; K23AI065806/AI/NIAID NIH HHS
Reg. No./Substance:
0/Bacterial Toxins

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