ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2019
Toxin Enzyme Immunoassays Detect Clostridioides difficile Infection With Greater Severity and Higher Recurrence Rates.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 33 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
33 citing papers in PubMed, 1 synthesis or guideline pooled it, 57 citations in OpenAlex.
- Clinical significance of toxin EIA positivity in patients with suspectedJournal of clinical microbiology · 2025Pooled it
- Safety and Tolerability of SER-109 as an Investigational Microbiome Therapeutic in Adults With Recurrent Clostridioides difficile Infection: A Phase 3, Open-Label, Single-Arm Trial.JAMA network open · 2023Trial
- Effect of the ribotype 027 strain on Clostridioides difficile infection outcomes and recurrence in the Veterans Affairs healthcare system: a propensity scores matching study.BMC infectious diseases · 2026Article
- Clinical outcomes of toxin-positive versus toxin-negative/NAAT-positive Clostridioides difficile infection in South Korea: a single-center retrospective cohort study.BMC infectious diseases · 2026Article
- Clinical features of NAAT-positive, toxin-negative Clostridioides difficile infections in South Korea.The Korean journal of internal medicine · 2026Article
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- Three stages of laboratory stewardship in improving appropriateAntimicrobial stewardship & healthcare epidemiology : ASHE · 2025Article
- Integrated Safety and Efficacy Analyses of Phase 3 Trials of a Microbiome Therapeutic for Recurrent CDI.Infectious diseases and therapy · 2024Article
- Article
- Potential underreporting of treated patients using aInfection control and hospital epidemiology · 2024Observational
- Clinical outcomes and treatment necessity in patients with toxin-negative Clostridioides difficile stool samples.Annals of clinical microbiology and antimicrobials · 2024Article
- Review
- Virulence and genomic diversity among clinical isolates of ST1 (BI/NAP1/027) Clostridioides difficile.Cell reports · 2023Article
- Trends in and Risk Factors for Recurrent Clostridioides difficile Infection, New Haven County, Connecticut, USA, 2015-2020.Emerging infectious diseases · 2023Review
- Novel Biomarkers, IncludingInfection and immunity · 2023Article
- Impact of Nucleic Acid Amplification Test on Clinical Outcomes in Patients withAntibiotics (Basel, Switzerland) · 2023Article
- Virulence and genomic diversity among clinical isolates of ST1 (BI/NAP1/027)bioRxiv : the preprint server for biology · 2023Article
- Risk Factors Associated with Severe Clostridioides difficile Infection in Patients with Cancer.Infectious diseases and therapy · 2023Article
- Comparison of the Risk of RecurrentOpen forum infectious diseases · 2022Article
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18 authors at 10 institutions in 1 country.
Funding
Abstract
backgroundFew data suggest that Clostridioides difficile infections (CDIs) detected by toxin enzyme immunoassay (EIA) are more severe and have worse outcomes than those detected by nucleic acid amplification tests (NAATs) only. We compared toxin- positive and NAAT-positive-only CDI across geographically diverse sites.
methodsA case was defined as a positive C. difficile test in a person ≥1 year old with no positive tests in the prior 8 weeks. Cases were detected during 2014-2015 by a testing algorithm (specimens initially tested by glutamate dehydrogenase and toxin EIA; if discordant results, specimens were reflexed to NAAT) and classified as toxin positive or NAAT positive only. Medical charts were reviewed. Multivariable logistic regression models were used to compare CDI-related complications, recurrence, and 30-day mortality between the 2 groups.
resultsOf 4878 cases, 2160 (44.3%) were toxin positive and 2718 (55.7%) were NAAT positive only. More toxin-positive than NAAT-positive-only cases were aged ≥65 years (48.2% vs 38.0%; P < .0001), had ≥3 unformed stools for ≥1 day (43.9% vs 36.6%; P < .0001), and had white blood cell counts ≥15 000 cells/µL (31.4% vs 21.4%; P < .0001). In multivariable analysis, toxin positivity was associated with recurrence (adjusted odds ratio [aOR], 1.89; 95% confidence interval [CI], 1.61-2.23), but not with CDI-related complications (aOR, 0.91; 95% CI, .67-1.23) or 30-day mortality (aOR, 0.95; 95% CI, .73-1.24).
conclusionsToxin-positive CDI is more severe, but there were no differences in adjusted CDI-related complication and mortality rates between toxin-positive and NAAT-positive-only CDI that were detected by an algorithm that utilized an initial glutamate dehydrogenase screening test.
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