Missed Diagnoses Common for C. Diff Infections

February 18, 2021
Kenny Walter

Kenny Walter is an editor with HCPLive. Prior to joining MJH Life Sciences in 2019, he worked as a digital reporter covering nanotechnology, life sciences, material science and more with R&D Magazine. He graduated with a degree in journalism from Temple University in 2008 and began his career as a local reporter for a chain of weekly newspapers based on the Jersey shore. When not working, he enjoys going to the beach and enjoying the shore in the summer and watching North Carolina Tar Heel basketball in the winter.

Strategic Alliance Partnership | <b>NYU Langone Health</b>

Missed diagnosis resulted in delays in initiation of therapy and hospital re-admissions.

New research suggests more attention paid to missed Clostridioides difficile infections (C diff).

A team, led by Ioannis M. Zacharioudakis, MD, Division of Infectious Diseases and Immunology, Department of Medicine, NYU School of Medicine, examined the rate of missed community-onset C diff infection diagnosis and associated outcomes.

Microbiology laboratories often blind the C diff BioFire FilmArray GI Panel due to fear of an over-diagnosis.

C. Diff Patients

The study included 144 adult patients with FilmArray GI Panel positives for C diff on hospital admission, but lacked dedicated C diff testing. Of this group, 18 individuals did not have concurrent dedicated C diff testing, while 8 patients were categorized as possible, 5 were deemed probably, and 4 were identified as definite missed CDI diagnosis.

The researchers found associated delays in initiation of appropriate therapy, intensive care unit admissions, hospital re-admission, colorectal surgery, and death or discharge to hospice.

In addition, 5 of 17 individuals lacked true risk factors for a C diff infection.

“The practice of concealing C. difficile FilmArray GI Panel results needs to be re-considered in patients presenting with community-onset colitis,” the authors wrote.

Common Complications

Recently, researchers found sepsis was a common C diff complication throughout a 12-month follow-up period and was most commonly observed in the cohort of patients with 3 or more C diff infection recurrences.

Investigators from around New England conducted a retrospective analysis of more than 46,000 adult patients with C diff infection in order to evaluate the clinical complications of C diff in patients with index and recurrent cases.

The investigators used the IQVIA PharMetrics Plus database to looks for patients aged 18-64 years with an index C diff episode that required inpatient stay or an outpatient visit, followed by a treatment for the infection. Treatments included vancomycin, fidaxomicin, metronidazole, rifaximin, or bezlotoxumab, or fecal microbiota transplant (FMT – though it was rare).

A total of 3129 patients (6.7%) experienced 1 recurrence, while 1% had 2 recurrences, and 0.3% had 3 or more recurrences. The study authors also noted that autoimmune diseases, such as ulcerative colitis, Crohn’s disease, type 1 diabetes, rheumatoid arthritis and multiple sclerosis, were present in 18%, 23%, 24%, and nearly 40% of patients, respectively, in patients with 0, 1, 2, or 3 or more C diff infection recurrences.

Antibiotics were prescribed for three-quarters of all patients in all groups in the 6 months preceding the index C diff infection, the investigators found. Gastric acid-suppressing agents were prescribed in 28%, 33%, 39%, and 38%, respectively, in patients with 0, 1, 2, or 3 or more C diff infection recurrences, the study authors also noted.

During the 12-month follow-up period, the investigators observed sepsis in 16%, 27%, 33%, and 43%, respectively, in patients with 0, 1, 2, or 3 or more C diff infection recurrences. No patient had more than 2 sepsis episodes during the 12-month follow-up period. Additionally, subtotal colectomy or diverting loop ileostomy was performed in 4%, 7%, 9%, and 10% of patients, respectively, in patients with 0, 1, 2, or 3 or more C diff infection recurrences.

The study, “Rate and Consequences of Missed Clostridioides (Clostridium) difficile Infection Diagnosis from Non-reporting of Clostridioides difficile Results of the Multiplex GI PCR Panel: Experience from Two-Hospitals,” was published online in Diagnostic Microbiology and Infectious Disease.