Open AccessPredicting Clostridium difficile Stool Cytotoxin Results in Hospitalized Patients with Diarrhea
Author(s) -
Katz David A.,
Bates David W.,
Rittenberg Eve,
Onderdonk Andrew,
Sands Kenneth,
Barefoot Laurie A.,
Snydman David
Publication year - 1997
Publication title -
journal of general internal medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.746
H-Index - 180
eISSN - 1525-1497
pISSN - 0884-8734
DOI - 10.1046/j.1525-1497.1997.12108.x
Subject(s) - medicine , clostridium difficile , diarrhea , antibiotics , abdominal pain , antibiotic associated diarrhea , cohort study , prospective cohort study , gastroenterology , microbiology and biotechnology , biology
OBJECTIVE: To validate a model for the prediction of Clostridium difficile cytotoxin assay results, and to identify a subgroup of patients with a very low likelihood of C. difficile –associated disease in whom the yield of routine cytotoxin testing is low. DESIGN: Prospective cohort study. Relevant clinical symptoms, signs, and antibiotic exposure were recorded before reporting of assay results. Each predictor was assigned a score based on regression coefficients, and patients were stratified according to their total score. SETTING: Two urban, tertiary care, university hospitals. PATIENTS: A total of 609 consecutive adult inpatients who received testing for C. difficile cytotoxin during a 3‐month period in 1994. MEASUREMENTS AND MAIN RESULTS: The prevalence of positive cytotoxin assays was 8% in the validation set, compared with 14% in the derivation set. Defining patients without both prior antibiotic use and at least one symptom predictor (significant diarrhea or abdominal pain) as a low‐risk subgroup, the misclassification rate was 2.8% (5/177) for assay results; of the five misclassified cases patients, only one was judged to have C. difficile –associated disease. Use of this rule to identify low‐risk patients could have potentially averted 29% of all cytotoxin assays. CONCLUSIONS: Patients without a history of antibiotic use and either significant diarrhea or abdominal pain are unlikely to have positive C. difficile cytotoxin assays and may not require cytotoxin testing.