Evaluating outpatient diagnostic stewardship of comprehensive polymerase chain reaction Clostridioides difficile testing in a regional health system
Abstract Objective: We examined the use of comprehensive and targeted polymerase chain reaction (PCR) of Clostridioides difficile infection (CDI) among immunocompetent patients with and without CDI risk factors across different outpatient settings. A priori, we expected patients with higher CDI ri...
| Main Authors: | , |
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| Format: | Article |
| Language: | English |
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Cambridge University Press
2023-01-01
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| Series: | Antimicrobial Stewardship & Healthcare Epidemiology |
| Subjects: | |
| Online Access: | https://www.cambridge.org/core/product/identifier/S2732494X23004266/type/journal_article |
| _version_ | 1797692696900403200 |
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| author | Ilya Golovaty Luis Tulloch-Palomino |
| author_facet | Ilya Golovaty Luis Tulloch-Palomino |
| author_sort | Ilya Golovaty |
| collection | DOAJ |
| description |
Abstract
Objective:
We examined the use of comprehensive and targeted polymerase chain reaction (PCR) of Clostridioides difficile infection (CDI) among immunocompetent patients with and without CDI risk factors across different outpatient settings. A priori, we expected patients with higher CDI risk to be associated with targeted testing to reflect providers incorporating pretest risk factors in their choice of test assay.
Design:
Retrospective analysis of adult patients from clinic, emergency room, and non-medically acute inpatient settings.
Setting:
A tertiary academic medical center offering inpatient and outpatient medical, surgical, mental health, and rehabilitation services to Veterans across the Puget Sound region.
Patients:
Immunocompetent adult patients with ≥1 stool PCR assay performed between January 2016 and December 2019.
Intervention:
Patients were tested with either a specific tcdB PCR assay or a comprehensive gastrointestinal PCR panel that tests for 22 pathogens.
Results:
A total of 2,717 tests (74% targeted, 26% comprehensive) were obtained from 2,156 patients, among which 13% detected C. difficile and 7% detected other organisms. The proportion of comprehensive PCR tests increased nearly four-fold from 2016 to 2019 in clinic and emergency room settings, independent of CDI risk factors. Only two CDI risk factors (prior history of CDI and antibiotic use within three months before testing) were associated with increased targeted testing.
Conclusion:
The use of comprehensive GI PCR among immunocompetent adults with diarrhea is increasing in the outpatient setting. There may be an opportunity for diagnostic stewardship by nudging providers to consider all CDI risk factors at the time of test selection.
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| first_indexed | 2024-03-12T02:32:19Z |
| format | Article |
| id | doaj.art-de8bdd4f47894239a57bfccee64e21af |
| institution | Directory Open Access Journal |
| issn | 2732-494X |
| language | English |
| last_indexed | 2024-03-12T02:32:19Z |
| publishDate | 2023-01-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | Antimicrobial Stewardship & Healthcare Epidemiology |
| spelling | doaj.art-de8bdd4f47894239a57bfccee64e21af2023-09-05T07:50:01ZengCambridge University PressAntimicrobial Stewardship & Healthcare Epidemiology2732-494X2023-01-01310.1017/ash.2023.426Evaluating outpatient diagnostic stewardship of comprehensive polymerase chain reaction Clostridioides difficile testing in a regional health systemIlya Golovaty0https://orcid.org/0000-0002-6493-0499Luis Tulloch-Palomino1https://orcid.org/0000-0001-6787-1140General Medicine Service, VA Puget Sound Health Care System, Seattle, WA, USA Division of General Internal Medicine, University of Washington School of Medicine, Seattle, WA, USAHospital and Specialty Medicine, VA Puget Sound Health Care System, Seattle, WA, USA Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington School of Medicine, Seattle, WA, USA Abstract Objective: We examined the use of comprehensive and targeted polymerase chain reaction (PCR) of Clostridioides difficile infection (CDI) among immunocompetent patients with and without CDI risk factors across different outpatient settings. A priori, we expected patients with higher CDI risk to be associated with targeted testing to reflect providers incorporating pretest risk factors in their choice of test assay. Design: Retrospective analysis of adult patients from clinic, emergency room, and non-medically acute inpatient settings. Setting: A tertiary academic medical center offering inpatient and outpatient medical, surgical, mental health, and rehabilitation services to Veterans across the Puget Sound region. Patients: Immunocompetent adult patients with ≥1 stool PCR assay performed between January 2016 and December 2019. Intervention: Patients were tested with either a specific tcdB PCR assay or a comprehensive gastrointestinal PCR panel that tests for 22 pathogens. Results: A total of 2,717 tests (74% targeted, 26% comprehensive) were obtained from 2,156 patients, among which 13% detected C. difficile and 7% detected other organisms. The proportion of comprehensive PCR tests increased nearly four-fold from 2016 to 2019 in clinic and emergency room settings, independent of CDI risk factors. Only two CDI risk factors (prior history of CDI and antibiotic use within three months before testing) were associated with increased targeted testing. Conclusion: The use of comprehensive GI PCR among immunocompetent adults with diarrhea is increasing in the outpatient setting. There may be an opportunity for diagnostic stewardship by nudging providers to consider all CDI risk factors at the time of test selection. https://www.cambridge.org/core/product/identifier/S2732494X23004266/type/journal_articlediagnostic stewardshipClostridioides difficile testingcomprehensive stool PCRPCRmolecular management |
| spellingShingle | Ilya Golovaty Luis Tulloch-Palomino Evaluating outpatient diagnostic stewardship of comprehensive polymerase chain reaction Clostridioides difficile testing in a regional health system Antimicrobial Stewardship & Healthcare Epidemiology diagnostic stewardship Clostridioides difficile testing comprehensive stool PCR PCR molecular management |
| title | Evaluating outpatient diagnostic stewardship of comprehensive polymerase chain reaction Clostridioides difficile testing in a regional health system |
| title_full | Evaluating outpatient diagnostic stewardship of comprehensive polymerase chain reaction Clostridioides difficile testing in a regional health system |
| title_fullStr | Evaluating outpatient diagnostic stewardship of comprehensive polymerase chain reaction Clostridioides difficile testing in a regional health system |
| title_full_unstemmed | Evaluating outpatient diagnostic stewardship of comprehensive polymerase chain reaction Clostridioides difficile testing in a regional health system |
| title_short | Evaluating outpatient diagnostic stewardship of comprehensive polymerase chain reaction Clostridioides difficile testing in a regional health system |
| title_sort | evaluating outpatient diagnostic stewardship of comprehensive polymerase chain reaction clostridioides difficile testing in a regional health system |
| topic | diagnostic stewardship Clostridioides difficile testing comprehensive stool PCR PCR molecular management |
| url | https://www.cambridge.org/core/product/identifier/S2732494X23004266/type/journal_article |
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