ArticleEuropean journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology2018
Clinical heterogeneity of patients with stool samples testing PCR+/Tox- from a two-step Clostridium difficile diagnostic algorithm.
Article in European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 1 of them a synthesis that pooled it.
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Who cites it
14 citing papers in PubMed, 1 synthesis or guideline pooled it, 24 citations in OpenAlex.
- Clinical significance of toxin EIA positivity in patients with suspectedJournal of clinical microbiology · 2025Pooled it
- Randomized Controlled Trial of Oral Vancomycin Treatment in Clostridioides difficile-Colonized Patients.mSphere · 2021Trial
- Clinical features of NAAT-positive, toxin-negative Clostridioides difficile infections in South Korea.The Korean journal of internal medicine · 2026Article
- Clinical Impact of Stool Polymerase Chain Reaction (PCR) Testing in Hospitalized Patients with Acute Diarrhea: A Retrospective Observational Study.Biomedicines · 2025Article
- Potential underreporting of treated patients using aInfection control and hospital epidemiology · 2024Observational
- Evaluation of a two step testing algorithm to improve diagnostic accuracy and stewardship of Clostridioides difficile infections.BMC research notes · 2023Article
- Syndromic Panel Testing Among Patients With Infectious Diarrhea: The Challenge of InterpretingOpen forum infectious diseases · 2023Article
- The Current Knowledge onPathogens (Basel, Switzerland) · 2022Review
- Optimizing the interpretation ofAntimicrobial stewardship & healthcare epidemiology : ASHE · 2022Article
- Diagnostic Methods ofAntibiotics (Basel, Switzerland) · 2021Article
- Review
- Predictors of Clostridioides difficile Infection-Related Complications and Treatment Patterns among Nucleic Acid Amplification Test-Positive/Toxin Enzyme Immunoassay-Negative Patients.Journal of clinical microbiology · 2020Article
- Prospective Review ofInfection prevention in practice · 2019Article
- Clostridioides difficile-Associated Diarrhea: Infection Prevention Unknowns and Evolving Risk Reduction Strategies.Current infectious disease reports · 2019Review
Corrections and comments
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Authors and funding
11 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The clinical significance of indeterminate (PCR+/Tox-) results for patients tested with a two-step algorithm for Clostridium difficile infection (CDI) is uncertain. We aimed to evaluate the clinical presentation and 8-week outcomes of patients with indeterminate test results. Patients with stool samples testing positive by PCR and negative by toxin A/B immunoassay between February 1, 2017, and April 30, 2018, were assessed by antimicrobial stewardship program (ASP) clinicians and classified as colonized or infected. Retrospective chart review was performed to obtain outcomes occurring within 8 weeks of testing, including recurrent C. difficile diarrhea, subsequent treatment for CDI, follow-up C. difficile testing, all-cause mortality, and CDI-related complications. In total, 110 PCR+/Tox- patients were evaluated. ASP classified 54% of patients as infected and 46% as colonized. Patients assessed and classified as colonized did not have increased adverse outcomes by 8 weeks compared to those assessed as infected, despite not receiving treatment for CDI. We conclude that PCR+/Tox- patients are heterogeneous with respect to clinical presentation. Negative toxin A/B immunoassay in a two-step algorithm should not be interpreted in isolation to distinguish colonization from infection as many PCR+/Tox- results may be clinically significant for CDI.
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