Two-Step Testing Helps Predict and Treat Recurrent C difficile Infection

Sustainable Development Goals (SDGs) and Clostridioides difficile Infection

Introduction

This article was originally published on Contagion Live. It has been lightly edited.

Clostridioides difficile is a bacterium that can cause life-threatening diarrhea and disease in individuals with dysbiosis of the gut microbiota. The CDC estimates there are close to half a million C difficile infections (CDIs) each year in the United States alone.

Risk Factors and Treatment

Risk factors for severe or fatal CDI include age 65 years or older, a current or recent hospital or nursing home stay, a weakened immune system, and/or a previous CDI. Rapid testing and treatment implementation is the best way to increase the odds of survival in these at-risk individuals and the overall population.

2-Step Testing Algorithm

Polymerase chain reaction (PCR) testing is highly sensitive for C difficile detection. Additionally, some clinical laboratories have implemented a 2-step testing algorithm, consisting of a PCR test and toxin enzyme immunoassay (EIA) to ensure proper diagnosis.

Study on Risk Factors and Outcomes

One study, published in Infection Control & Hospital Epidemiology, sought to determine the risk factors and outcomes of C difficile PCR positive/toxin-positive patients compared to PCR-positive/toxin-negative patients. The study’s primary outcome was the frequency of CDI treatment initiation.

Methodology

The retrospective case-control study was conducted at a Veterans Affairs hospital. Included patient encounters had a positive C difficile PCR test and either a toxin EIA-positive assay (confirmed cases) or toxin EIA-negative assay (controls). Available encounter stool specimens were cultured for C difficile and restriction endonuclease analysis (REA) strain typing was performed. At 30 days, the investigators assessed CDI recurrence according to clinically relevant exposures and risk factors.

Results

Among 130 C difficile PCR-positive patient encounters, the investigators determined 61.5% (n = 80) were toxin EIA negative and 38.5% (n = 50) were toxin EIA positive. Toxin-positive patents were tested more frequently (96.0%) than the toxin-negative patients.

Multivariable logistic regression modelling revealed that toxin-negative patients were less likely to experience a recurrent CDI episode within 30 days (odds ratio [OR], 0.20, 95% CI, 0.05–0.83). A higher C difficile PCR cycle threshold also predicted a lower risk of CDI recurrence at 30 days (OR, 0.82; 95% CI, 0.68-0.98).

Notably, during the study period, the REA group Y strain accounted for most toxin-negative patient encounters (32.5%; P = .05), while REA group BI strain accounted for most toxin-positive encounters (24.3%; P = .02).

Conclusion

CDI treatment was initiated in 99% of patients according to the 1-step method and in 79% of patients subjected to the 2-step method. The investigators determined that the testing strategy of PCR plus toxin EIA was a helpful predictor of recurrent CDI.

Reference

Crone AS, Wright LM, Cheknis A, Johnson S, Pacheco SM, Skinner AM. Characteristics and outcomes of Clostridioides difficile infection after a change in the diagnostic testing algorithm. Infect Control Hosp Epidemiol. Published online July 18, 2023. doi:10.1017/ice.2023.145

SDGs, Targets, and Indicators

1. SDG 3: Good Health and Well-being

   • Target 3.3: By 2030, end the epidemics of AIDS, tuberculosis, malaria, and neglected tropical diseases and combat hepatitis, water-borne diseases, and other communicable diseases.
   • Indicator: Number of new cases and deaths from communicable diseases, including Clostridioides difficile infection (CDI).

2. SDG 6: Clean Water and Sanitation

   • Target 6.1: By 2030, achieve universal and equitable access to safe and affordable drinking water for all.
   • Indicator: Proportion of the population using safely managed drinking water services.

Explanation:

1. The article addresses SDG 3: Good Health and Well-being, as it discusses the impact of Clostridioides difficile infection (CDI) on individuals’ health. CDI is a communicable disease that can cause life-threatening diarrhea and disease.

   • The specific target under SDG 3 that can be identified is Target 3.3, which aims to end the epidemics of communicable diseases like CDI by 2030.
   • The article mentions the number of CDI infections each year in the United States, which can serve as an indicator to measure progress towards Target 3.3.

2. The article also connects to SDG 6: Clean Water and Sanitation, as CDI is caused by a bacterium that can thrive in environments with dysbiosis of the gut microbiota.

   • The specific target under SDG 6 that can be identified is Target 6.1, which aims to achieve universal access to safe drinking water.
   • The article does not mention any specific indicators related to SDG 6, but the provision of safe drinking water can be used as an indicator to measure progress towards Target 6.1.

Behold! This splendid article springs forth from the wellspring of knowledge, shaped by a wondrous proprietary AI technology that delved into a vast ocean of data, illuminating the path towards the Sustainable Development Goals. Remember that all rights are reserved by SDG Investors LLC, empowering us to champion progress together.

Source: ajmc.com

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