1
|
Ramirez JA, Angulo FJ, Carrico RM, Furmanek S, Oliva SP, Zamparo JM, Gonzalez E, Zhang P, Parrish LAW, Marimuthu S, Pride MW, Gray S, Matos Ferreira CS, Arnold FW, Istúriz RE, Minarovic N, Moïsi JC, Jodar L. Misdiagnosis of Clostridioides difficile Infections by Standard-of-Care Specimen Collection and Testing among Hospitalized Adults, Louisville, Kentucky, USA, 2019-2020 1. Emerg Infect Dis 2023; 29:919-928. [PMID: 37080953 PMCID: PMC10124648 DOI: 10.3201/eid2905.221618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Abstract
Although Clostridioides difficile infection (CDI) incidence is high in the United States, standard-of-care (SOC) stool collection and testing practices might result in incidence overestimation or underestimation. We conducted diarrhea surveillance among inpatients >50 years of age in Louisville, Kentucky, USA, during October 14, 2019-October 13, 2020; concurrent SOC stool collection and CDI testing occurred independently. A study CDI case was nucleic acid amplification test‒/cytotoxicity neutralization assay‒positive or nucleic acid amplification test‒positive stool in a patient with pseudomembranous colitis. Study incidence was adjusted for hospitalization share and specimen collection rate and, in a sensitivity analysis, for diarrhea cases without study testing. SOC hospitalized CDI incidence was 121/100,000 population/year; study incidence was 154/100,000 population/year and, in sensitivity analysis, 202/100,000 population/year. Of 75 SOC CDI cases, 12 (16.0%) were not study diagnosed; of 109 study CDI cases, 44 (40.4%) were not SOC diagnosed. CDI incidence estimates based on SOC CDI testing are probably underestimated.
Collapse
|
2
|
Yin C, Song Z, Wang X, Li H, Liu Y, Wang Q, Feng X, Song X. Development and clinical application of a rapid, visually interpretable polymerase spiral reaction for tcdB gene of Clostridioides difficile in fecal cultures. FEMS Microbiol Lett 2023; 370:fnad080. [PMID: 37537148 DOI: 10.1093/femsle/fnad080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 06/14/2023] [Accepted: 08/02/2023] [Indexed: 08/05/2023] Open
Abstract
In the surveillance of outbreaks of Clostridioides difficile infection, the rapid detection and diagnosis of C. difficile remain a major challenge. Polymerase spiral reaction (PSR) is a nucleic acid amplification technique that uses mixed primers and the strand displacement activity of Bst DNA polymerase to achieve a pair of primers and a single enzyme in an isothermal environment. The primer design is simple, the reaction is efficient, and a color indicator can be used to visualize the result. In this study, we developed a rapid and visually interpretable PSR to detect C. difficile by analyzing artificially contaminated feces samples and clinical isolates from patient feces samples. We designed two pairs of primers for a PSR that specifically targeted the conserved tcdB gene of C. difficile. The amplification results were visualized with the chromogenic dye hydroxynaphthol blue. The entire process was accomplished in 50 min at 64°C, with high specificity. The limit of detection of C. difficile with PSR was 150 fg/μl genomic DNA or 2 × 10 CFU/ml in artificially contaminated feces samples. With this method, we analyzed four clinical isolates and also compared the PSR with an isolation-and-culture detection method, polymerase chain reaction, and the Sanger sequencing. The four clinical isolates were found positive for tcdB, which confirmed the high specificity of the primers. The positive rates of tcdB in toxigenic C. difficile detected with PSR, PCR, and Sanger sequencing were 100%. The proportions of toxin types in these clinical C. difficile strains were 50% tcdA+tcdB+CDT- and 50% tcdA+tcdB+CDT+. The assay described should extend our understanding of the incidence of C. difficile. This may allow the rapid diagnosis and screening of C. difficile-related disease outbreaks in the field.
Collapse
Affiliation(s)
- Caihong Yin
- Department of Hygienic Inspection, School of Public Health, Jilin University, 1163 Xinmin Street, Changchun 130021, China
| | - Zhanyun Song
- Changchun Customs Technology Center, 4448 Freedom Road, Changchun, China
| | - Xianghui Wang
- Changchun Customs Technology Center, 4448 Freedom Road, Changchun, China
| | - Hui Li
- Changchun Customs Technology Center, 4448 Freedom Road, Changchun, China
| | - Yue Liu
- Department of Hygienic Inspection, School of Public Health, Jilin University, 1163 Xinmin Street, Changchun 130021, China
| | - Qiulin Wang
- Department of Hygienic Inspection, School of Public Health, Jilin University, 1163 Xinmin Street, Changchun 130021, China
| | - Xin Feng
- School of Public Health, College of Veterinary Medicine, Jilin University, 5333 Xi 'an Road, Changchun, China
| | - Xiuling Song
- Department of Hygienic Inspection, School of Public Health, Jilin University, 1163 Xinmin Street, Changchun 130021, China
| |
Collapse
|
3
|
Tateda K, Ishida J, Ito S, Gonzalez E, Yoshizumi S, Zhang P, Pride M, Gray S, Ferreira CM, Minarovic N, Angulo FJ, Moïsi JC, Jodar L. Population-based incidence of hospitalized Clostridioides difficile infection among older adults in Ota-ku, Japan: A prospective surveillance study. Anaerobe 2022; 76:102607. [PMID: 35787452 DOI: 10.1016/j.anaerobe.2022.102607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/15/2022] [Accepted: 06/18/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Clostridioides difficile infection (CDI) burden is not well-characterized in Japan. Therefore, we conducted a population-based, hospitalized CDI incidence study, compared the results with standard-of-care (SOC) CDI testing, and generalized the results for nationwide incidence estimates. METHODS Surveillance identified inpatients ≥50 years-of-age with diarrhea in nine Tokyo hospitals from December 17, 2018-March 30, 2020. A CDI case was defined as a patient with a PCR-positive/cell cytotoxicity neutralization assay (CCNA)-positive stool or a PCR-positive stool and pseudomembranous colitis (PMC). Incidence estimates were adjusted for the hospitalization share of participating hospitals and, in the sensitivity analysis, for missing CDI test results. SOC specimen collection and CDI testing occurred independently. RESULTS Surveillance during 318 840 patient-days identified 4633 inpatients with diarrhea. Sixty-three CDI cases were identified; 11 (17·5%) had PMC, eight (12·7%) recurrent CDI, and nine (14·3%) died. The hospitalized CDI incidence was 97/100 000 population per year (PPY) in persons ≥50 years-of-age and, in the sensitivity analysis, 324/100 000 PPY. The incidence was 170 and 481/100 000 PPY in persons ≥65 and ≥ 85 years-of-age, respectively; these estimates increased to 569 and 1609/100 000 PPY in the sensitivity analysis, respectively. There were 12 primary SOC CDI cases in persons ≥50 years-of-age (18/100 000 PPY). CONCLUSIONS The CDI incidence was high in older adults, with severe clinical consequences. SOC specimen collection and testing under-estimated CDI burden. There are >57 000 hospitalized CDI cases per year in Japan in persons ≥50 years-of-age. Public health interventions are needed to reduce the CDI burden in Japan.
Collapse
Affiliation(s)
- Kazuhiro Tateda
- Toho University School of Medicine, Department of Microbiology and Infectious Diseases, 5-21-16, Omori-Nishi Ota-ku, Tokyo, 143-8530, Japan.
| | - Junro Ishida
- Den-en-chofu Central Hospital, Department of General Medicine, 2-43-1, Den-en-chofu, Ota-ku, Tokyo, 145-0071, Japan.
| | - Shuhei Ito
- Vaccine Medical Affairs, Pfizer Japan Inc., 3-22-7 Yoyogi, Shibuya-ku, Tokyo, 151-8589, Japan.
| | - Elisa Gonzalez
- Medical Development and Scientific/Clinical Affairs, Pfizer Vaccines, Collegeville, PA, 19301, USA.
| | - Satoshi Yoshizumi
- Parexel International, 1-21-2 Shinkawa, Chuo-ku, Tokyo, 104-0033, Japan.
| | - Pingping Zhang
- Medical Development and Scientific/Clinical Affairs, Pfizer Vaccines, Collegeville, PA, 19301, USA.
| | - Michael Pride
- Vaccine Research and Development, Pfizer, Pearl River, NY, 10965, USA.
| | - Sharon Gray
- Medical Development and Scientific/Clinical Affairs, Pfizer Vaccines, Collegeville, PA, 19301, USA.
| | - Cátia Matos Ferreira
- Medical Development and Scientific/Clinical Affairs, Pfizer Vaccines, Collegeville, PA, 19301, USA.
| | - Nadia Minarovic
- Medical Development and Scientific/Clinical Affairs, Pfizer Vaccines, Collegeville, PA, 19301, USA.
| | - Frederick J Angulo
- Medical Development and Scientific/Clinical Affairs, Pfizer Vaccines, Collegeville, PA, 19301, USA.
| | - Jennifer C Moïsi
- Medical Development and Scientific/Clinical Affairs, Pfizer Vaccines, Collegeville, PA, 19301, USA.
| | - Luis Jodar
- Medical Development and Scientific/Clinical Affairs, Pfizer Vaccines, Collegeville, PA, 19301, USA.
| | | |
Collapse
|