Test for Cure, Overdiagnosis, Recurrent CDI

This article popped up in my morning reading, and I think it’s really important. Over diagnosis and overtreatment cause big problems. This is exactly why the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) guidelines say do not test for cure. You should test if symptoms return. Even then, they caution that treatment should not be prescribed based on test alone but rather based on clinical symptoms and more than one test (ex. PCR and EIA). That’s because you may get false positives and start unnecessary treatment that could actually cause recurrent CDI. The PCR detects the presence of the strain of bacteria, not active infection (I.e it tells you’re a carrier). 

Some key points from the article:

➡️ “Notably, the widespread use of the highly sensitive NAAT and its relatively lower clinical specificity have led to overdiagnosis of C. difficile by identifying carriers when NAAT is used as the sole diagnostic method.”

➡️ “…Lee and colleagues suggested multistep testing approaches …could include an initial test of either GDH or NAAT, followed by toxins A/B EIA alongside lab stewardship that assures appropriate test orders and feedback.”

➡️ “Recognition of clinical CDI and distinguishing this entity from asymptomatic carriage or colonization are crucial to achieve the dual goals of reducing CDI rates and the risk for antibacterial resistant C. difficile strains.”

Read all my C-diff posts here.

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