Hostname: page-component-586b7cd67f-rdxmf Total loading time: 0 Render date: 2024-11-28T07:44:38.595Z Has data issue: false hasContentIssue false
  • English
  • Français

Healthcare provider diagnostic testing practices for identification of Clostridioides (Clostridium) difficile in children: an Emerging Infections Network survey

Published online by Cambridge University Press:  15 February 2019

Larry K. Kociolek Open the ORCID record for Larry K. Kociolek [Opens in a new window] ,
Preeta K. Kutty ,
Philip M. Polgreen  and
Susan E. Beekmann
Larry K. Kociolek*
Affiliation:
Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois Division of Infectious Diseases, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
Preeta K. Kutty
Affiliation:
Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Philip M. Polgreen
Affiliation:
Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa Emerging Infections Network, Iowa City, Iowa
Susan E. Beekmann
Affiliation:
Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa Emerging Infections Network, Iowa City, Iowa
*
Author for correspondence: Larry K. Kociolek, Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To characterize healthcare provider diagnostic testing practices for identifying Clostridioides (Clostridium) difficile infection (CDI) and asymptomatic carriage in children.

Design:

Electronic survey.

Methods:

An 11-question survey was sent by e-mail or facsimile to all pediatric infectious diseases (PID) members of the Infectious Diseases Society of America’s Emerging Infections Network (EIN).

Results:

Among 345 eligible respondents who had ever responded to an EIN survey, 196 (57%) responded; 162 of these (83%) were aware of their institutional policies for CDI testing and management. Also, 159 (98%) respondents knew their institution’s C. difficile testing method: 99 (62%) utilize NAAT without toxin testing and 60 (38%) utilize toxin testing, either as a single test or a multistep algorithm. Of 153 respondents, 10 (7%) reported that formed stools were tested for C. difficile at their institution, and 76 of 151 (50%) reported that their institution does not restrict C. difficile testing in infants and young children. The frequency of symptom- and age-based testing restrictions did not vary between institutions utilizing NAAT alone compared to those utilizing toxin testing for C. difficile diagnosis. Of 143 respondents, 26 (16%) permit testing of neonatal intensive care unit patients and 12 of 26 (46%) treat CDI with antibiotics in this patient population.

Conclusions:

These data suggest that there are opportunities to improve CDI diagnostic stewardship practices in children, including among hospitals using NAATs alone for CDI diagnosis in children.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 3 , March 2019 , pp. 276 - 280
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Burnham, CA, Carroll, KC. Diagnosis of Clostridium difficile infection: an ongoing conundrum for clinicians and for clinical laboratories. Clin Microbiol Rev 2013;26:604–630.CrossRefGoogle ScholarPubMed
Kociolek, LK. Strategies for optimizing the diagnostic predictive value of Clostridium difficile molecular diagnostics. J Clin Microbiol 2017;55:1244–1248.CrossRefGoogle ScholarPubMed
Pillai, SK, Beekmann, SE, Santibanez, S, Polgreen, PM. The Infectious Diseases Society of America emerging infections network: bridging the gap between clinical infectious diseases and public health. Clin Infect Dis 2014;58:991–996.CrossRefGoogle Scholar
McDonald, LC, Gerding, DN, Johnson, S, et al. Clinical practice guidelines for Clostridium difficile infection in adults and children: 2017 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin Infect Dis 2018;66:e1–e48.CrossRefGoogle Scholar
Tamma, PD, Sandora, TJ. Clostridium difficile infection in children: current state and unanswered questions. J Pediatric Infect Dis Soc 2012;1:230–243.CrossRefGoogle ScholarPubMed
Schutze, GE, Willoughby, RE, et al. Clostridium difficile infection in infants and children. Pediatrics 2013;131:196–200.Google ScholarPubMed
Kociolek, LK, Bovee, M, Carter, D, et al. Impact of a healthcare provider educational intervention on frequency of Clostridium difficile polymerase chain reaction testing in children: a segmented regression analysis. J Pediatric Infect Dis Soc 2017;6:142–148.Google ScholarPubMed
Nicholson, MR, Freswick, PN, Di Pentima, MC, et al. The use of a computerized provider order entry alert to decrease rates of Clostridium difficile testing in young pediatric patients. Infect Control Hosp Epidemiol 2017;38:542–546.CrossRefGoogle ScholarPubMed
Truong, CY, Gombar, S, Wilson, R, et al. Real-time electronic tracking of diarrheal episodes and laxative therapy enables verification of Clostridium difficile clinical testing criteria and reduction of Clostridium difficile infection rates. J Clin Microbiol 2017;55:1276–1284.CrossRefGoogle ScholarPubMed
Leibowitz, J, Soma, VL, Rosen, L, Ginocchio, CC, Rubin, LG. Similar proportions of stool specimens from hospitalized children with and without diarrhea test positive for Clostridium difficile. Pediatr Infect Dis J 2015;34:261–266.CrossRefGoogle ScholarPubMed
Dominguez, SR, Dolan, SA, West, K, et al. High colonization rate and prolonged shedding of Clostridium difficile in pediatric oncology patients. Clin Infect Dis 2014;59:401–403.CrossRefGoogle ScholarPubMed
Fong, KS, Fatica, C, Hall, G, et al. Impact of PCR testing for Clostridium difficile on incident rates and potential on public reporting: is the playing field level? Infect Control Hosp Epidemiol 2011;32:932–933.CrossRefGoogle ScholarPubMed
Supplementary material: PDF

Kociolek et al. supplementary material

Kociolek et al. supplementary material 1

Download Kociolek et al. supplementary material(PDF)
PDF 130.5 KB