ADVERTISEMENT
Hospital-Onset CDI Incidence, Antibiotic Use Drop With Two-Step Testing
Two-step testing for Clostridioides difficile infection (CDI) was associated with decreased incidence of hospital-onset CDI and C difficile–specific antibiotic use at a handful of regional hospitals, according to study results published online ahead of print in Clinical Infectious Diseases.
“Two-step testing for CDI aims to improve diagnostic specificity but may also influence reported epidemiology and patterns of treatment,” wrote corresponding author Nicholas A Turner, MD, MHSc, of Duke University Medical Center, Durham, North Carolina, and study coauthors. “Some providers fear that two-step testing may result in adverse outcomes if C difficile is underdiagnosed.”
The study looked at the impact of two-step testing on hospital-onset CDI incidence and, as proxies for harm from underdiagnosis or delayed treatment, C difficile–specific antibiotic use and colectomy rates. The study included approximately 2.7 million patient days across 8 regional hospitals from July 2017 through March 2022.
With two-step testing, the reported incidence of hospital-onset CDI decreased, according to the study. Researchers reported a 0.53 incidence rate ratio and credited the decrease to improved diagnostic specificity.
Use of oral vancomycin and fidaxomicin showed a similar level decrease, with a utilization rate ratio of 0.63. Meanwhile, emergent colectomy rates did not significantly change.
“The parallel decrease in C difficile–specific antibiotic use offers indirect reassurance against underdiagnosis of C difficile infections still requiring treatment by clinician assessment,” researchers wrote. “Similarly, the absence of any significant change in colectomy rates offers indirect reassurance against any rise in fulminant C difficile requiring surgical management.”
Reference:
Turner NA, Krishnan J, Nelson A, et al. Assessing the impact of two-step Clostridioides difficile testing at the healthcare facility level. Clin Infect Dis. Published online June 6, 2023. doi:10.1093/cid/ciad334
© 2023 HMP Global. All Rights Reserved.
Any views and opinions expressed are those of the author(s) and/or participants and do not necessarily reflect the views, policy, or position of First Report Managed Care or HMP Global, their employees, and affiliates.
