Misdiagnosis of C diff by Specimen Collection and Testing
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Misdiagnosis of Clostridioides Difficile Infections by Standard-of-Care Specimen Collection and Testing Among Hospitalized Adults, Louisville, Kentucky, USA, 2019–20201

Julio A. Ramirez; Frederick J. Angulo; Ruth M. Carrico; Stephen Furmanek; Senén Peña Oliva; Joann M. Zamparo; Elisa Gonzalez; Pingping Zhang; Leslie A. Wolf Parrish; Subathra Marimuthu; Michael W. Pride; Sharon Gray; Cátia S. Matos Ferreira; Forest W. Arnold; Raul E. Istúriz; Nadia Minarovic; Jennifer C. Moïsi; Luis Jodar

Disclosures

Emerging Infectious Diseases. 2023;29(5):919-928. 

In This Article

Abstract and Introduction

Abstract

Although Clostridioides difficile infection (CDI) incidence is high in the United States, standard-of-care (SOC) stool collection and testing practices might result in incidence overestimation or underestimation. We conducted diarrhea surveillance among inpatients ≥50 years of age in Louisville, Kentucky, USA, during October 14, 2019–October 13, 2020; concurrent SOC stool collection and CDI testing occurred independently. A study CDI case was nucleic acid amplification test–/cytotoxicity neutralization assay–positive or nucleic acid amplification test–positive stool in a patient with pseudomembranous colitis. Study incidence was adjusted for hospitalization share and specimen collection rate and, in a sensitivity analysis, for diarrhea cases without study testing. SOC hospitalized CDI incidence was 121/100,000 population/year; study incidence was 154/100,000 population/year and, in sensitivity analysis, 202/100,000 population/year. Of 75 SOC CDI cases, 12 (16.0%) were not study diagnosed; of 109 study CDI cases, 44 (40.4%) were not SOC diagnosed. CDI incidence estimates based on SOC CDI testing are probably underestimated.

Introduction

Clostridioides difficile infection (CDI) is a major cause of illness and death worldwide.[1,2] The Centers for Disease Control and Prevention (CDC) classifies CDI as an urgent public health threat.[3]In the CDC Emerging Infections Program (EIP), the CDI incidence in persons ≥50 years of age was 255/100,000 population in 2019, and the hospitalized CDI incidence in this age group was 140/100,000 population.

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