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Mandatory reporting and improvements in diagnosing Clostridium difficile infection: an incompatible dichotomy?
- Source :
- The Journal of infection. 62(5)
- Publication Year :
- 2011
-
Abstract
- Summary Toxin enzyme immunoassays (EIAs) are inadequate for the diagnosis of Clostridium difficile infection (CDI) when used alone. In September 2010 we replaced toxin EIA with a two-step algorithm, testing first with glutamate dehydrogenase and confirming with polymerase chain reaction for toxin B gene. We compared this to the gold standard of toxigenic culture, observing a positive predictive value of 96% (laboratory prevalence of 4.7%). There was no deterioration in turnaround time but there was a decrease of 11% in repeat specimens sent from the same patients. The improved performance of the algorithm increased the laboratory positivity rate from 2.2% to 5.6%. This led to an increase in our Trust CDI rate reported under the Health Protection Agency's mandatory surveillance scheme. We investigated whether the change was due to increasing nosocomial transmission, environmental contamination or consumption of antimicrobials, but found no evidence of this. We conclude that it probably resulted from the change in testing algorithm. Although we have improved testing and enhanced patient safety, we are likely to be unfairly financially penalised because of our apparent (but not real) increase in CDI rates. Assessment of CDI rates should take testing methodology into account and national policies should be revised to reflect this.
- Subjects :
- Microbiology (medical)
Mandatory reporting
medicine.medical_specialty
Clostridium difficile toxin B
Sensitivity and Specificity
Microbiology
Predictive Value of Tests
Internal medicine
medicine
Humans
Aged
Aged, 80 and over
Immunoassay
business.industry
Clinical Laboratory Techniques
Clostridioides difficile
Nosocomial transmission
Infant, Newborn
Infant
Gold standard (test)
Clostridium difficile
Mandatory Reporting
Middle Aged
Predictive value
Improved performance
Infectious Diseases
Clostridium Infections
Enzyme immunoassays
business
Algorithms
Subjects
Details
- ISSN :
- 15322742
- Volume :
- 62
- Issue :
- 5
- Database :
- OpenAIRE
- Journal :
- The Journal of infection
- Accession number :
- edsair.doi.dedup.....fddbb0d1c08837f5181d6e1eb52df74e