Toxin Enzyme Immunoassays Detect Clostridioides difficile Infection With Greater Severity and Higher Recurrence Rates

Author:

Guh Alice Y1,Hatfield Kelly M1,Winston Lisa G2,Martin Brittany3,Johnston Helen4,Brousseau Geoffrey4,Farley Monica M56,Wilson Lucy7,Perlmutter Rebecca7,Phipps Erin C89,Dumyati Ghinwa K10,Nelson Deborah10,Hatwar Trupti10,Kainer Marion A11,Paulick Ashley L1,Karlsson Maria1,Gerding Dale N1213,McDonald L Clifford1

Affiliation:

1. Centers for Disease Control and Prevention, Atlanta, Georgia

2. School of Medicine, University of California, San Francisco

3. California Emerging Infections Program, Oakland

4. Colorado Department of Public Health and Environment, Denver

5. Emory University School of Medicine, Atlanta, Georgia

6. Veterans Affairs Medical Center, Atlanta, Georgia

7. Maryland Department of Health, Baltimore

8. University of New Mexico, Albuquerque

9. New Mexico Emerging Infections Program, Albuquerque

10. New York Emerging Infections Program and University of Rochester Medical Center, Nashville

11. Tennessee Department of Health, Nashville

12. Stritch School of Medicine, Loyola University Chicago, Maywood

13. Edward Hines Jr Veterans Affairs Hospital, Hines, Illinois

Abstract

Abstract Background Few data suggest that Clostridioides difficile infections (CDIs) detected by toxin enzyme immunoassay (EIA) are more severe and have worse outcomes than those detected by nucleic acid amplification tests (NAATs) only. We compared toxin- positive and NAAT-positive-only CDI across geographically diverse sites. Methods A case was defined as a positive C. difficile test in a person ≥1 year old with no positive tests in the prior 8 weeks. Cases were detected during 2014–2015 by a testing algorithm (specimens initially tested by glutamate dehydrogenase and toxin EIA; if discordant results, specimens were reflexed to NAAT) and classified as toxin positive or NAAT positive only. Medical charts were reviewed. Multivariable logistic regression models were used to compare CDI-related complications, recurrence, and 30-day mortality between the 2 groups. Results Of 4878 cases, 2160 (44.3%) were toxin positive and 2718 (55.7%) were NAAT positive only. More toxin-positive than NAAT-positive-only cases were aged ≥65 years (48.2% vs 38.0%; P < .0001), had ≥3 unformed stools for ≥1 day (43.9% vs 36.6%; P < .0001), and had white blood cell counts ≥15 000 cells/µL (31.4% vs 21.4%; P < .0001). In multivariable analysis, toxin positivity was associated with recurrence (adjusted odds ratio [aOR], 1.89; 95% confidence interval [CI], 1.61–2.23), but not with CDI-related complications (aOR, 0.91; 95% CI, .67–1.23) or 30-day mortality (aOR, 0.95; 95% CI, .73–1.24). Conclusions Toxin-positive CDI is more severe, but there were no differences in adjusted CDI-related complication and mortality rates between toxin-positive and NAAT-positive-only CDI that were detected by an algorithm that utilized an initial glutamate dehydrogenase screening test.

Funder

National Center for Emerging and Zoonotic Infectious Diseases

Publisher

Oxford University Press (OUP)

Subject

Infectious Diseases,Microbiology (medical)

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