Volume 29, Number 5—May 2023
Research
Misdiagnosis of Clostridioides difficile Infections by Standard-of-Care Specimen Collection and Testing among Hospitalized Adults, Louisville, Kentucky, USA, 2019–20201
, Ruth M. Carrico2, Stephen Furmanek2, Senén Peña Oliva, Joann M. Zamparo, Elisa Gonzalez, Pingping Zhang, Leslie A. Wolf Parrish, Subathra Marimuthu, Michael W. Pride, Sharon Gray, Cátia S. Matos Ferreira3, Forest W. Arnold, Raul E. Istúriz, Nadia Minarovic, Jennifer C. Moïsi, and Luis Jodar
Table 3
Comparison between SOC-diagnosed primary CDI cases (n = 126) and study-diagnosed but not SOC-diagnosed primary CDI cases (n = 44) in study of misdiagnosis of CDI by SOC specimen collection and testing among hospitalized adults, Louisville, Kentucky, USA, October 14, 2019–April 11, 2020*
| Characteristic | SOC-diagnosed primary CDI cases, n =126 | Study-diagnosed but not SOC-diagnosed primary CDI cases, n = 44† | p value |
|---|---|---|---|
| Demographics | |||
| Median age, y, (IQR) | 73 (61‒81) | 67 (59‒76) | 0.13 |
| Female sex |
74 (58.7) |
27 (61.4) |
0.76 |
| Signs and symptoms | |||
| Fever | 11 (9.1) | 6 (13.6) | 0.40 |
| Nausea | 38 (34.5) | 11 (25.5) | 0.29 |
| Abdominal cramping | 19 (19.2) | 5 (12.8) | 0.37 |
| Dehydration |
13 (12.5) |
2 (5.3) |
0.21 |
| Location of diarrhea onset | |||
| Hospital-onset‡ |
22 (17.5) |
19 (43.2) |
<0.01 |
| Medical history | |||
| Dementia | 14 (11.1) | 4 (9.1) | 0.71 |
| Cancer | 42 (33.3) | 11 (25.0) | 0.30 |
| Congestive heart disease | 41 (32.5) | 23 (52.3) | 0.02 |
| Pneumonia | 33 (26.2) | 13 (29.5) | 0.67 |
| Inflammatory bowel disease | 17 (13.5) | 3 (6.8) | 0.24 |
| Diabetes |
47 (37.3) |
21 (47.7) |
0.22 |
| Medical course | |||
| Recurrence | 4 (3.2) | 0 (0) | 0.23 |
| PMC | 26 (20.8) | 0 (0) | <0.01 |
| Transferred to ICU | 36 (28.6) | 18 (40.9) | 0.13 |
| Death at 90 days | 20 (15.9) | 7 (15.9) | 1.00 |
*Values are no. (%) except as indicated. CDI, Clostridioides difficile infection; ICU, intensive care unit; IQR, interquartile range; PMC, pseudomembranous colitis; SOC, standard-of-care. †Includes 28 study-diagnosed primary CDI cases that did not have SOC testing and 16 study-diagnosed primary CDI cases that had SOC testing but were not SOC-diagnosed primary CDI cases. ‡Defined as onset of diarrhea ≥3 days after hospital admission.
1Study results were presented at the annual Anaerobe 2022 Congress, July 28–31, 2022, Seattle, Washington, USA.
2Current affiliation: Norton Healthcare, Louisville, Kentucky, USA.
3Current affiliation: AstraZeneca Pharmaceuticals, Wilmington, Delaware, USA.