Clinical studyClinical prediction rules to optimize cytotoxin testing for Clostridium difficile in hospitalized patients with diarrhea
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Cited by (48)
A systematic review of tools for predicting complications in patients with acute infectious diarrhea
2023, American Journal of Emergency MedicineCitation Excerpt :Risk stratification tools may help predict the need for investigation or treatment and thereby optimize the use of healthcare resources. A large number of these tools have been shown to improve cost-effectiveness while minimizing unnecessary diagnostic imaging, treatment complications, and unnecessary admissions [5-9]. Most of these tools have been developed as decision aids for physicians, and few are intended to help patients and caregivers identify the most appropriate care pathway for the condition [10,11].
Lack of improvement in antimicrobial prescribing after a diagnosis of Clostridium difficile and impact on recurrence
2018, American Journal of Infection ControlCitation Excerpt :Patient demographics including age, sex, site of initial diagnosis (inpatient or outpatient), primary service (medicine-primary care or surgery), CDI risk factors (recent hospitalization, intensive care unit [ICU] admission, proton-pump inhibitor [PPI] use, and type 2 histamine receptor [H2R] blocker use), immunocompromised state (HIV, hematologic malignancy, chemotherapy, biologic anti-inflammatory, and chronic high-dose steroids), and tube feed use were also reviewed. Retrospective review of each case was performed to ensure that subjects met the clinical definition of CDI, which was defined as watery diarrhea with colitis (≥3 loose bowel movements per 24 hours or liquid colostomy output of ≥1,300 mL/d over 2 days) or unexplained lower abdominal pain, ileus, fever, and leukocytosis, in the setting of positive C difficile testing.1,25 Recurrence was defined as resolution of symptoms after completing appropriate therapy for iCDI, as defined by Infectious Diseases Society of America guidelines,1,3 followed by subsequent recurrence of symptoms associated with positive repeat toxin testing.21,26,27
Integration of technology into clinical practice
2013, Clinics in Laboratory MedicineCitation Excerpt :By age 3, carriage rates are similar to that of nonhospitalized adults (less than 3%).58,59 However, carriage rates in hospitalized patients may be 10% or more.60 Given these high rates of asymptomatic carriage, it is likely that indiscriminant testing for C. difficile will result in a high number of misleading positive results and clinical confusion.
Peripartum Clostridium difficile infection: case series and review of the literature
2008, American Journal of Obstetrics and GynecologyCitation Excerpt :Each patient's stool sample was tested for the presence of C difficile toxin B by the cytotoxin assay in the hospital diagnostic microbiology laboratory.7 Anaerobic culture was performed on all C difficile toxin B–positive stool specimens by plating specimens onto cycloserine-cefoxitin-fructose agar media (CCFA-VA formulation; Remel, Lenexa, KS).8,9 Plates were incubated anaerobically with the Anaero Pouch System (Remel) at 35°C for up to 5 days before a final interpretation of a negative result was determined.
Laboratory diagnosis of Clostridium difficile-associated disease in the Republic of Ireland: a survey of Irish microbiology laboratories
2008, Journal of Hospital InfectionCitation Excerpt :With regard to which patients to test, in one study prior antibiotic therapy, significant diarrhoea (defined as new onset of more than three partially formed or watery stools per 24 h period) and abdominal pain were independent predictors of a positive cytotoxin assay result. A decision rule (defined as positive if prior antibiotic use and either significant diarrhoea or abdominal pain are present) that was applied to specimens before testing demonstrated sensitivity and specificity of 86 and 45%, leading the authors to conclude that patients without prior antibiotic use and either significant diarrhoea or abdominal pain may not routinely require cytotoxin testing.17 One of the main disadvantages of this approach is the reliance on accurate clinical data being recorded on sample submission to the laboratory, which in practice may be an unattainable goal.
Reducing Clostridium difficile Colitis Rates Via Cost-Saving Diagnostic Stewardship
2018, Infection Control and Hospital Epidemiology
- 1
Dr. Katz was supported by a Veterans Administration fellowship in ambulatory care at the time of this work. An earlier version of this work was previously presented at the Society of Medical Decision Making Annual Meeting, Research Triangle Park, NC, October 24–27, 1993.
- 2
Dr. Littenberg's current address: Washington University School of Medicine, Campus Box 8005, 660 South Euclid Avenue, St. Louis, Missouri 63110.