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Clinical Characteristics and Outcomes of Hematologic Malignancy Patients With Positive Clostridium difficile Toxin Immunoassay Versus Polymerase Chain Reaction Test Results

Published online by Cambridge University Press:  25 April 2018

Matthew Ziegler*
Affiliation:
Division of Infectious Diseases, Department of Healthcare Epidemiology, Infection Prevention and Control Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Daniel Landsburg
Affiliation:
Division of Hematology and Oncology, Department of Healthcare Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
David Pegues
Affiliation:
Division of Infectious Diseases, Department of Healthcare Epidemiology, Infection Prevention and Control Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Department of Healthcare Epidemiology, Infection Prevention and Control Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Kevin Alby
Affiliation:
Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Cheryl Gilmar
Affiliation:
Department of Healthcare Epidemiology, Infection Prevention and Control Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Kristen Bink
Affiliation:
Division of Hematology and Oncology, Department of Healthcare Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Theresa Gorman
Affiliation:
Division of Hematology and Oncology, Department of Healthcare Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Amy Moore
Affiliation:
Division of Hematology and Oncology, Department of Healthcare Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Brittaney Bonhomme
Affiliation:
Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Jacqueline Omorogbe
Affiliation:
Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Dana Tango
Affiliation:
Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Pam Tolomeo
Affiliation:
Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Jennifer H. Han
Affiliation:
Division of Infectious Diseases, Department of Healthcare Epidemiology, Infection Prevention and Control Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Department of Healthcare Epidemiology, Infection Prevention and Control Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
*
Address correspondence to Matthew Ziegler, MD, 3400 Spruce St, 3 Silverstein, Suite E Philadelphia, PA 19104 ([email protected]).

Abstract

In a cohort of inpatients with hematologic malignancy and positive enzyme immunoassay (EIA) or polymerase chain reaction (PCR) Clostridium difficile tests, we found that clinical characteristics and outcomes were similar between these groups. The method of testing is unlikely to predict infection in this population, and PCR-positive results should be treated with concern.

Infect Control Hosp Epidemiol 2018;863–866

Type
Concise Communication
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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Footnotes

PREVIOUS PRESENTATION. The interim results of this study were presented at the Infectious Disease Society of America IDWeek as a poster (Presentation #1291) on October 6th, in San Diego, California.

References

REFERENCES

1. Bruminhent, J, Wang, ZX, Hu, C, et al. Clostridium difficile colonization and disease in patients undergoing hematopoietic stem cell transplantation. Biol Blood Marrow Transpl 2014;20:13291334.CrossRefGoogle ScholarPubMed
2. Jain, T, Croswell, C, Urday-Cornejo, V, et al. Clostridium difficile colonization in hematopoietic stem cell transplant recipients: a prospective study of the epidemiology and outcomes involving toxigenic and nontoxigenic strains. Biol Blood Marrow Transpl 2016;22:157163.CrossRefGoogle ScholarPubMed
3. Dubberke, ER, Han, Z, Bobo, L, et al. Impact of clinical symptoms on interpretation of diagnostic assays for Clostridium difficile infections. J Clin Microbiol 2011;49:28872893.CrossRefGoogle ScholarPubMed
4. Truong, C, Schroeder, LF, Gaur, R, et al. Clostridium difficile rates in asymptomatic and symptomatic hospitalized patients using nucleic acid testing. Diagn Microbiol Infect Dis 2017;87:365370.CrossRefGoogle ScholarPubMed
5. Akahoshi, Y, Kimura, S, Nakano, H, et al. Significance of a positive Clostridium difficile toxin test after hematopoietic stem cell transplantation. Clin Transplant 2016;30:703708.CrossRefGoogle ScholarPubMed
6. Stein, A, Voigt, W, Jordan, K. Chemotherapy-induced diarrhea: pathophysiology, frequency and guideline-based management. Ther Adv Med Oncol 2010;2:5163.Google Scholar
7. Polage, CR, Gyorke, CE, Kennedy, MA, et al. Overdiagnosis of Clostridium difficile infection in the molecular test era. JAMA Intern Med 2015;175:17921801.Google Scholar
8. Origuen, J, Corbella, L, Orellana, MA, et al. Comparison of the clinical course of Clostridium difficile infection in GDH-positive, toxin-negative patients diagnosed by PCR to those with a positive toxin test. Clin Microbiol Infect 2017;pii:S1198-743X(17)30431-7. doi: 10.1016/j.cmi.2017.07.033.CrossRefGoogle Scholar
9. Surawicz, CM, Brandt, LJ, Binion, DG, et al. Guidelines for diagnosis, treatment, and prevention of Clostridium difficile infections. Am J Gastroenterol 2013;108:478498.Google Scholar
10. Planche, TD, Davies, KA, Coen, PG, et al. Differences in outcome according to Clostridium difficile testing method: a prospective multicentre diagnostic validation study of C. difficile infection. Lancet Infect Dis 2013;13:936945.Google Scholar
11. Chakrabarti, S, Lees, A, Jones, SG, Milligan, DW. Clostridium difficile infection in allogeneic stem cell transplant recipients is associated with severe graft-versus-host disease and non-relapse mortality. Bone Marrow Transpl 2000;26:871876.CrossRefGoogle ScholarPubMed