Diagnostic Stewardship Approaches to Clostridioides difficile Infection in the Era of Two-Step Testing: a Shifting Lands
- PDF / 442,026 Bytes
- 17 Pages / 595.276 x 790.866 pts Page_size
- 36 Downloads / 176 Views
Microbial Stewardship (M Stevens, Section Editor)
Diagnostic Stewardship Approaches to Clostridioides difficile Infection in the Era of Two-Step Testing: a Shifting Landscape Jennifer Emberger, MD, MPH1,* Matthew M. Hitchcock, MD, MPH1,2 J. Daniel Markley, DO, MPH1,2 Address *,1 Department of Internal Medicine, Division of Infectious Diseases, Virginia Commonwealth University Medical Center, VMI Building, 2nd Floor, Room 205, Richmond, VA, 23298, USA Email: [email protected] 2 Department of Medicine, Division of Infectious Diseases, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA, USA
* Springer Science+Business Media, LLC, part of Springer Nature 2020
This article is part of the Topical Collection on Microbial Stewardship Keywords Diagnostic stewardship I Two-step testing I Clostridioides difficile
Abstract Purpose of review To discuss the current strategies and impact of diagnostic stewardship for Clostridioides difficile infection. Recent findings The diagnosis of C. difficile infection is challenging due to complex epidemiology and the limitations of a single assay that is adequate for diagnosis. Overdiagnosis with sensitive molecular assays is common due to the prevalence of colonization with C. difficile. To overcome these challenges, multiple diagnostic stewardship strategies have been successfully deployed to optimize C. difficile testing. Summary Diagnostic stewardship strategies should be implemented at every stage of C. difficile testing in order to limit testing to patients with a high pre-test probability, minimize the limitations of stand-alone assays, and guide clinicians to appropriate management through clear result reporting and interpretation.
Microbial Stewardship (M Stevens, Section Editor)
Introduction While pseudomembranous colitis (PMC) was first identified histopathologically in the 1890s and Clostridioides (previously Clostridium) difficile was isolated as a colonizing organism in infants in 1935, the two were not linked until the late 1970s when PMC was revealed to be a toxin-mediated Clostridial process [1–3]. Today, C. difficile infection (CDI) is considered one of the five urgent public health threats included in the Centers for Disease Control and Prevention’s (CDC) Antibiotic Resistance Threats in the United States 2019 report [4]. In 2017, there were approximately 224,000 cases of CDI in hospitalized patients and 12,800 deaths [4]. In 2020, the diagnosis of CDI can be made using a variety of tests, but due to limitations in diagnostic accuracy and an evolving understanding of the degree of C. difficile carriage within patient populations, the optimal diagnostic strategy remains undefined [5–7]. Unfortunately, no validated diagnostic criteria for CDI exist at this time. As our understanding of CDI epidemiology and diagnostic
limitations expands, the role of diagnostic stewardship has become increasingly relevant. Diagnostic stewardship is an emerging term for the careful use of diagnostics in order to focus testing toward higher-probability s
Data Loading...
