Are We Moving Toward Diagnostic Stewardship Or Laboratory Retrogress On Clostridioides difficile Testing?
The widespread adoption of PCR-based testing for Clostridioides difficile infection (CDI) has replaced enzyme immunoassays (EIA) in the U.S., increasing sensitivity and reported healthcare-onset CDI (HO-CDI) cases. However, concerns about overdiagnosis persist, as PCR may detect asymptomatic coloniz...
| Publicado en: | Sage Open Pathology Vol. 19; pp. 1 - 9 |
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| Autores principales: | , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Sage Publications Inc.
6/16/2026
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=194639663&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 194639663 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 30502098 NYAB jtl: Sage Open Pathology issn: 30502098 maglogo: N pubinfo: dt: 6/16/2026 vid: 19 pid: 344 pub: Sage Publications Inc. place: Thousand Oaks, California artinfo: ui: 194639663 194639663 194639663 10.1177/30502098261451758 194639663 ppf: 1 ppct: 8 formats: fmt: – @attributes: type: T – @attributes: type: P tig: atl: Are We Moving Toward Diagnostic Stewardship Or Laboratory Retrogress On Clostridioides difficile Testing? aug: au: Navarathna, Dhammika H. Cornelius, Lisa Lukey, Janell Wiley, Linda K. San Juan, Ma Rowena Bolin, Sara C. affil: Department of Pathology and Laboratory Medicine Services, Central Texas Veterans Health Care System, Temple, TX, USA sug: subj: Clostridium Infections Diagnosis Diagnosis, Laboratory Methods Sensitivity and Specificity Evaluation Health Services Misuse Overdiagnosis Polymerase Chain Reaction Immunoenzyme Techniques Incident Reports Patient Safety Quality Improvement Clinical Laboratories, Hospital Human Microbial Culture and Sensitivity Tests Clostridioides Difficile Analysis Clostridium Infections Symptoms Bacterial Colonization Comparative Studies Inpatients Laboratory Personnel Education Diagnostic Reasoning Decision Making, Clinical Electronic Order Entry Algorithms Patient Care Molecular Biology Clinical Research Practice Guidelines Texas Pearson's Correlation Coefficient Two-Tailed Test Data Analysis Software ab: The widespread adoption of PCR-based testing for Clostridioides difficile infection (CDI) has replaced enzyme immunoassays (EIA) in the U.S., increasing sensitivity and reported healthcare-onset CDI (HO-CDI) cases. However, concerns about overdiagnosis persist, as PCR may detect asymptomatic colonization. To mitigate this, some institutions use a 2-step algorithm, confirming positive PCR/GDH results with EIA. Our healthcare system, which exclusively reports PCR results, conducted a process improvement (PI) project to evaluate whether incorporating EIA testing could improve hospital reporting and patient safety. We compared our routine PCR testing with 2 commercial EIA platforms to assess sensitivity and specificity and analyzed PCR cycle threshold (Ct) values in relation to EIA results. EIA tests demonstrated less than 30% sensitivity compared to PCR, artificially reducing HO-CDI cases. Few inpatients tested by PCR despite not meeting CDI testing criteria had positive EIA results, indicating true CDI and highlighting the need for better provider education. Lower PCR Ct values, reflecting higher bacterial loads, correlated with EIA positivity, suggesting that EIA requires higher toxin expression for detection. Implementing decision-making alerts in electronic ordering improved diagnostic stewardship. While multi-step testing algorithms may reduce HO-CDI rates, they risk excluding toxin-negative (false-negative) CDI due to EIA's low sensitivity. This approach offers limited clinical value in CDI management. Instead, reinforcing provider education on appropriate testing criteria is a more effective strategy to reduce unnecessary testing and improve patient care. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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