Clostridium difficile infections (CDI)
are a serious threat to public health. This often-deadly pathogen is the
leading cause of healthcare-associated infections in the United States,
representing nearly 500,000 cases annually. It is imperative that we find
effective ways to curb its transmission, particularly within hospitals and
other healthcare facilities, in order to improve patient outcomes and overall
human health.
Existing
guidelines for testing possible CDI cases restrict the use of molecular
diagnostics to very specific patient profiles. However, new studies have begun
to demonstrate that a broader approach to C.
difficile testing—comprehensive screening of patients admitted to
hospitals—could offer significant progress toward reducing the incidence of
nosocomial transmission.
Modifying
the way molecular diagnostics are used for this pathogen could dramatically
reduce the number of people infected with C.
difficile by allowing earlier identification and mitigation steps that can
limit its ability to spread. Since these infections often lead to chronic
health problems or even death, any reduction in incidence would provide a major
improvement to human health.
In recent
years, the guidelines for C. difficile
testing have changed. The guidance issued last year by the Infectious Diseases
Society of America and the Society for Healthcare Epidemiology of America
recommends using molecular diagnostics in a fairly narrow way. The primary
driver behind this decision is that molecular tests cannot differentiate
between cases where C. difficile is the causal pathogen and where it is a
harmless member of the patient’s intestinal microbiome.
To
avoid overdiagnosis of CDI, these guidelines suggest using molecular
diagnostics only when healthcare professionals have reason to believe the
patient is suffering from an active CDI. This is typically when a patient has
recently undergone antibiotic treatment or has experienced the onset of
symptoms after being admitted to the hospital for a number of days. In these
cases, the rapid turnaround time for a molecular assay offers an advantage for
guiding isolation and treatment.
Posted by Dr. Tim Sandle, Pharmaceutical Microbiology
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