ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2023
Assessing the Impact of 2-Step Clostridioides difficile Testing at the Healthcare Facility Level.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 1 of them a synthesis that pooled it.
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The trial behind it
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
12 citing papers in PubMed, 1 synthesis or guideline pooled it, 13 citations in OpenAlex.
- Clinical significance of toxin EIA positivity in patients with suspectedJournal of clinical microbiology · 2025Pooled it
- Implementation of two-stage testing forAntimicrobial stewardship & healthcare epidemiology : ASHE · 2026Article
- Epidemiologic validation of the National Healthcare Safety Network's updatedInfection control and hospital epidemiology · 2025Article
- Natural History of Clostridioides difficile-Related Disease Progression in the 2-Step Testing Era.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2025Article
- The Global Burden ofInfectious disease reports · 2025Review
- The evolving landscape of live biotherapeutics in the treatment of Clostridioides difficile infection.Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology · 2025Review
- Beyond the bugs: why toxin detection is key in two-tieredAntimicrobial stewardship & healthcare epidemiology : ASHE · 2025Article
- Impact of a multi-step testing algorithm on hospital-onsetAntimicrobial stewardship & healthcare epidemiology : ASHE · 2025Article
- Impact of the Reverse 2-Step Algorithm forOpen forum infectious diseases · 2024Article
- Diagnostic stewardship to improve patient outcomes and healthcare-associated infection (HAI) metrics.Infection control and hospital epidemiology · 2024Article
- CDC's Hospital-Onset Clostridioides difficile Prevention Framework in a Regional Hospital Network.JAMA network open · 2024Article
- Are We Moving Toward Diagnostic Stewardship Or Laboratory Retrogress OnSage open pathologyArticle
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Authors and funding
10 authors at 3 institutions in 1 country.
Funding
Abstract
backgroundTwo-step testing for Clostridioides difficile infection (CDI) aims to improve diagnostic specificity but may also influence reported epidemiology and patterns of treatment. Some providers fear that 2-step testing may result in adverse outcomes if C. difficile is underdiagnosed.
methodsOur primary objective was to assess the impact of 2-step testing on reported incidence of hospital-onset CDI (HO-CDI). As secondary objectives, we assessed the impact of 2-step testing on C. difficile-specific antibiotic use and colectomy rates as proxies for harm from underdiagnosis or delayed treatment. This longitudinal cohort study included 2 657 324 patient-days across 8 regional hospitals from July 2017 through March 2022. Impact of 2-step testing was assessed by time series analysis with generalized estimating equation regression models.
resultsTwo-step testing was associated with a level decrease in HO-CDI incidence (incidence rate ratio, 0.53 [95% confidence interval {CI}, .48-.60]; P < .001), a similar level decrease in utilization rates for oral vancomycin and fidaxomicin (utilization rate ratio, 0.63 [95% CI, .58-.70]; P < .001), and no significant level (rate ratio, 1.16 [95% CI, .93-1.43]; P = .18) or trend (rate ratio, 0.85 [95% CI, .52-1.39]; P = .51) change in emergent colectomy rates.
conclusionsTwo-step testing is associated with decreased reported incidence of HO-CDI, likely by improving diagnostic specificity. The parallel decrease in C. difficile-specific antibiotic use offers indirect reassurance against underdiagnosis of C. difficile infections still requiring treatment by clinician assessment. Similarly, the absence of any significant change in colectomy rates offers indirect reassurance against any rise in fulminant C. difficile requiring surgical management.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.