Identification of a pseudo-outbreak of Clostridium difficile infection (CDI) and the effect of repeated testing, sensitivity, and specificity on perceived prevalence of CDI

Infection Control and Hospital Epidemiology

Volumn 30, Issue 12, 2009, Pages 1166-1171

  Litvin, Marina ^a   Reske, Kimberly A ^a   Mayfield, Jennie ^b   Mcmullen, Kathleen M ^b   Georgantopoulos, Peter ^a   Copper, Susan ^b   Hoppe Bauer, Joan E ^b   Fraser, Victoria J ^a   Warren, David K ^a   Dubberke, Erik R ^a  

^a WASHINGTON UNIVERSITY SCHOOL OF MEDICINE   (United States)

^b BARNES JEWISH HOSPITAL   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ANALYTIC METHOD; ARTICLE; BACTERIUM DETECTION; CHI SQUARE TEST; CLOSTRIDIUM DIFFICILE; CLOSTRIDIUM DIFFICILE INFECTION; DIAGNOSTIC ERROR; DIAGNOSTIC TEST; EPIDEMIC; FALSE POSITIVE RESULT; HUMAN; INCIDENCE; MAJOR CLINICAL STUDY; PREDICTION; PREVALENCE; SENSITIVITY AND SPECIFICITY; THEORETICAL MODEL; TOXIN ANALYSIS;

ACADEMIC MEDICAL CENTERS; CLOSTRIDIUM DIFFICILE; CROSS INFECTION; DISEASE OUTBREAKS; ENTEROCOLITIS, PSEUDOMEMBRANOUS; ENTEROTOXINS; ENZYME-LINKED IMMUNOSORBENT ASSAY; FALSE POSITIVE REACTIONS; HUMANS; MISSOURI; PREVALENCE; REAGENT KITS, DIAGNOSTIC; SENSITIVITY AND SPECIFICITY;

EID: 73449096121     PISSN: 0899823X     EISSN: None     Source Type: Journal    
DOI: 10.1086/648089     Document Type: Article

References (20)

1. Goorhuis A, Van der Kooi T, Vaessen N, et al. Spread and epidemiology of Clostridium difficile polymerase chain reaction ribotype 027/toxinotype III in The Netherlands. Clin Infect Dis 2007;45:695-703.
2. Loo VG, Poirier L, Miller MA, et al. A predominantly clonal multiinstitutional outbreak of Clostridium difficile-associated diarrhea with high morbidity and mortality. N Engl J Med 2005;353:2442-2449.
3. McDonald LC, Owings M, Jernigan DB. Clostridium difficile infection in patients discharged from US short-stay hospitals, 1996-2003. Emerg Infect Dis 2006;12:409-415.
4. Gerding DN. New definitions will help, but cultures are critical for resolving unanswered questions about Clostridium difficile. Infect Control Hosp Epidemiol 2007;28:113-115.
5. Peterson LR, Manson RU, Paule SM, et al. Detection of toxigenic Clostridium difficile in stool samples by real-time polymerase chain reaction for the diagnosis of C. difficile-associated diarrhea. Clin Infect Dis 2007;45:1152-1160.
6. Gerding DN, Johnson S, Peterson LR, Mulligan ME, Silva JJr. Clostridium difficile-associated diarrhea and colitis. Infect Control Hosp Epidemiol 1995;16:459-477.
7. Johnson S, Homann SR, Bettin KM, et al. Treatment of asymptomatic Clostridium difficile carriers (fecal excretors) with vancomycin or metronidazole: a randomized, placebo-controlled trial. Ann Intern Med 1992;117:297-302.
8. Kirkland KB, Weinstein JM. Adverse effects of contact isolation. Lancet 1999;354:1177-1178.
9. Saint S, Higgins LA, Nallamothu BK, Chenoweth C. Do physicians examine patients in contact isolation less frequently? A brief report. Am J Infect Control 2003;31:354-356.
10. Stelfox HT, Bates DW, Redelmeier DA. Safety of patients isolated for infection control. JAMA 2003;290:1899-1905.
11. Campbell RJ, Giljahn L, Machesky K, et al. Clostridium difficile infection in Ohio hospitals and nursing homes during 2006. Infect Control Hosp Epidemiol 2009;30:526-533.
12. Eggertson L. Hospitals to report C. difficile and MRSA. CMAJ 2007;176:1402-1403.
13. McDonald LC, Coignard B, Dubberke E, Song X, Horan T, Kutty PK. Recommendations for surveillance of Clostridium difficile-associated disease. Infect Control Hosp Epidemiol 2007;28:140-145.
14. El Gammal A, Scotto V, Malik S, et al. Evaluation of the clinical usefulness of C. difficile toxin testing in hospitalized patients with diarrhea. Diagn Microbiol Infect Dis 2000;36:169-173.
15. Cardona DM, Rand KH. Evaluation of repeat Clostridium difficile enzyme immunoassay testing. J Clin Microbiol 2008;46:3686-3689.
16. Aichinger E, Schleck CD, Harmsen WS, Nyre LM, Patel R. Nonutility of repeat laboratory testing for detection of Clostridium difficile by use of PCR or enzyme immunoassay. J Clin Microbiol 2008;46:3795-3797.
17. Bennett RG, Laughon BE, Mundy LM, et al. Evaluation of a latex agglutination test for Clostridium difficile in two nursing home outbreaks. J Clin Microbiol 1989;27:889-893.
18. Mayer J, South B, Mooney B, et al. Surveillance of Clostridium difficile-associated disease based ib toxin enzyme immunoassay results: did a problem with testing lead to a pseudo-epidemic? In: 18th Annual Meeting of the Society for Healthcare Epidemiology of America. Arlington, VA: Society for Healthcare Epidemiology of America; 2008. Abstract 56.
19. Dubberke ER, Gerding DN, Classen D, et al. Strategies to prevent Clostridium difficile infections in acute care hospitals. Infect Control Hosp Epidemiol 2008;29(Suppl 1):S81-S92.
20. Mohan SS, McDermott BP, Parchuri S, Cunha BA. Lack of value of repeat stool testing for Clostridium difficile toxin. Am J Med 2006;119:356-358.