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Antimicrobial Prescribing Practices in Response to Different Clostridium difficile Diagnostic Methodologies

Published online by Cambridge University Press:  02 January 2015

Emily R. M. Sydnor ,
Abigail Lenhart ,
Brandon Trollinger ,
Edina Avdic ,
Lisa L. Maragakis ,
Karen C. Carroll  and
Sara E. Cosgrove
Emily R. M. Sydnor*
Affiliation:
Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
Abigail Lenhart
Affiliation:
Department of General Internal Medicine, Oregon Health and Science University, Portland, Oregon
Brandon Trollinger
Affiliation:
Johns Hopkins Health System, Johns Hopkins Hospital, Baltimore, Maryland
Edina Avdic
Affiliation:
Johns Hopkins Health System, Johns Hopkins Hospital, Baltimore, Maryland
Lisa L. Maragakis
Affiliation:
Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
Karen C. Carroll
Affiliation:
Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland Division of Medical Microbiology, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
Sara E. Cosgrove
Affiliation:
Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
*
Johns Hopkins Hospital, 600 North Wolfe Street, Osier 425, Baltimore, MD 21287 (esydnor1@jhmi.edu)
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Abstract

We evaluated treatment decisions and antimicrobial use related to 2 testing algorithms for Clostridium difficile infection (CDI). findings suggest that a 2-step testing algorithm using rapid polymerase chain reaction confirmatory testing leads to decreased unnecessary anti-CDI antimicrobial use. In addition, a significant proportion of patients with confirmed CDI were not treated accordingto recommended guidelines.

Type
Concise Communications
Information
Infection Control & Hospital Epidemiology , Volume 32 , Issue 11 , November 2011 , pp. 1133 - 1136
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

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References

1.Bartlett, JG. Narrative review: the new epidemic of Clostridium difficile-associated enteric disease. Ann Intern Med 2006; 145: 758–764.CrossRefGoogle ScholarPubMed
2.Reller, ME, Lema, CA, Perl, TM, et al. Yield of stool culture with isolate toxin testing versus a two-step algorithm including stool toxin testing for detection of toxigenic Clostridium difficile. J Clin Microbiol 2007;45:3601–3605.CrossRefGoogle ScholarPubMed
3.Carroll, KC. Tests for the diagnosis of Clostridium difficile infection: the next generation. Anaerobe 2011;17:170–174.CrossRefGoogle ScholarPubMed
4.Walker, RC, Ruane, PJ, Rosenblatt, JE, et al. Comparison of culture, cytotoxicity assays, and enzyme-linked immunosorbent assay for toxin A and toxin B in the diagnosis of Clostridium difficile-related enteric disease. Diagn Microbiol Infect Dis 1986; 5:61–69.CrossRefGoogle ScholarPubMed
5.Merz, CS, Kramer, C, Forman, M, et al. Comparison of four commercially available rapid enzyme immunoassays with cytotoxin assay for detection of Clostridium difficile toxin(s) from stool specimens. J Clin Microbiol 1994;32:1142–1147.CrossRefGoogle ScholarPubMed
6.Gerding, DN, Johnson, S, Peterson, LR, Mulligan, ME, Silva, J Jr. Clostridium difficile-associated diarrhea and colitis. Infect Control Hosp Epidemiol 1995;16:459–477.Google Scholar
7.Mohan, SS, McDermott, BP, Parchuri, S, Cunha, BA. Lack of value of repeat stool testing for Clostridium difficile toxin. Am J Med 2006;119:356.e7–8.Google Scholar
8.Ticehurst, JR, Aird, DZ, Dam, LM, Borek, AP, Hargrove, JT, Carroll, KC. Effective detection of toxigenic Clostridium difficile by a two-step algorithm including tests for antigen and cytotoxin. J Clin Microbiol 2006;44:1145–1149.Google Scholar
9.Gilligan, PH. Is a two-step glutamate dehyrogenase antigen-cytotoxicity neutralization assay algorithm superior to the premier toxin A and B enzyme immunoassay for laboratory detection of Clostridium difficile. J Clin Microbiol 2008;46: 1523–1525.Google Scholar
10.Stamper, PD, Alcabasa, R, Aird, D, et al. Comparison of a commercial real-time PCR assay for tcdB detection to a cell culture cytotoxicity assay and toxigenic culture for direct detection of toxin-producing Clostridium difficile in clinical samples. J Clin Microbiol 2009;47:373–378.Google Scholar
11.Bartlett, JG. Antimicrobial agents implicated in Clostridium difficile toxin-associated diarrhea of colitis. Johns Hopkins Med J 1981;149:6–9.Google ScholarPubMed
12.Kelly, CP, Pothoulakis, C, LaMont, JT. Clostridium difficile colitis. N Engl J Med 1994;330:257–262.Google Scholar
13.Cohen, SH, Gerding, DN, Johnson, S, et al. Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA). Infect Control Hosp Epidemiol 2010;31:431–455.Google Scholar