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Real-Time Polymerase Chain Reaction Detection of Asymptomatic Clostridium difficile Colonization and Rising C. difficile–Associated Disease Rates1

Published online by Cambridge University Press:  10 May 2016

Hoonmo L. Koo ,
John N. Van ,
Meina Zhao ,
Xunyan Ye ,
Paula A. Revell ,
Zhi-Dong Jiang ,
Carolyn Z. Grimes ,
Diana C. Koo ,
Todd Lasco  and
Claudia A. Kozinetz
...Show all authors
Hoonmo L. Koo
Affiliation:
Baylor College of Medicine, Houston, Texas University of Texas School of Public Health, Houston, Texas St. Luke’s Hospital, Houston, Texas
John N. Van
Affiliation:
Baylor College of Medicine, Houston, Texas
Meina Zhao
Affiliation:
Baylor College of Medicine, Houston, Texas
Xunyan Ye
Affiliation:
Baylor College of Medicine, Houston, Texas
Paula A. Revell
Affiliation:
Texas Children’s Hospital, Houston, Texas
Zhi-Dong Jiang
Affiliation:
University of Texas School of Public Health, Houston, Texas
Carolyn Z. Grimes
Affiliation:
University of Texas School of Public Health, Houston, Texas
Diana C. Koo
Affiliation:
University of Texas School of Public Health, Houston, Texas
Todd Lasco
Affiliation:
St. Luke’s Hospital, Houston, Texas
Claudia A. Kozinetz
Affiliation:
Baylor College of Medicine, Houston, Texas
Kevin W. Garey
Affiliation:
University of Texas School of Public Health, Houston, Texas St. Luke’s Hospital, Houston, Texas University of Houston College of Pharmacy, Houston, Texas
Herbert L. DuPont
Affiliation:
Baylor College of Medicine, Houston, Texas University of Texas School of Public Health, Houston, Texas St. Luke’s Hospital, Houston, Texas University of Texas Medical School at Houston, Houston, Texas
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Abstract

Objective.

To evaluate the accuracy of real-time polymerase chain reaction (PCR) for Clostridium difficile–associated disease (CDAD) detection, after hospital CDAD rates significantly increased following real-time PCR initiation for CDAD diagnosis.

Design.

Hospital-wide surveillance study following examination of CDAD incidence density rates by interrupted time series design.

Setting.

Large university-based hospital.

Participants.

Hospitalized adult patients.

Methods.

CDAD rates were compared before and after real-time PCR implementation in a university hospital and in the absence of physician and infection control practice changes. After real-time PCR introduction, all hospitalized adult patients were screened for C. difficile by testing a fecal specimen by real-time PCR, toxin enzyme-linked immunosorbent assay, and toxigenic culture.

Results.

CDAD hospital rates significantly increased after changing from cell culture cytotoxicity assay to a real-time PCR assay. One hundred ninety-nine hospitalized subjects were enrolled, and 101 fecal specimens were collected. C. difficile was detected in 18 subjects (18%), including 5 subjects (28%) with either definite or probable CDAD and 13 patients (72%) with asymptomatic C. difficile colonization.

Conclusions.

The majority of healthcare-associated diarrhea is not attributable to CDAD, and the prevalence of asymptomatic C. difficile colonization exceeds CDAD rates in healthcare facilities. PCR detection of asymptomatic C. difficile colonization among patients with non-CDAD diarrhea may be contributing to rising CDAD rates and a significant number of CDAD false positives. PCR may be useful for CDAD screening, but further study is needed to guide interpretation of PCR detection of C. difficile and the value of confirmatory tests. A gold standard CDAD diagnostic assay is needed.

Infect Control Hosp Epidemiol 2014;35(6):667–673

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 6 , 01 June 2014 , pp. 667 - 673
Copyright
© 2014 by The Society for Healthcare Epidemiology of America. All rights reserved.

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Footnotes

Presented in part: IDWeek 2013 Meeting; San Francisco, California; October 5, 2013.

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