Discordant Clostridioides difficile diagnostic assay and treatment practice: a cross-sectional study in a tertiary care hospital, Geneva, Switzerland

<p><b><span>Objectives:</span></b><span> </span><span><span>To determine the proportion of patients who received a treatment for </span><i><span>Clostridioides difficile</span></i><span> infection (CDI) among those presenting a discordant </span><i><span>Clostridioides difficile</span></i><span> diagnostic assay and to identify patient characteristics associated with the decision to treat CDI.</span></span></p> <p><b><span><span>Design: </span></span></b><span><span>Cross-sectional study.</span></span></p> <p><b><span><span>Setting: </span></span></b><span><span>Monocentric study in a tertiary care hospital, Geneva, Switzerland</span></span></p> <p><b><span>Participants: </span></b><span>Among 4562 adult patients tested for </span><i><span>C. difficile</span></i><span> between March 2017 and March 2019</span><span><span>, 208 patients with discordant tests' results</span></span><span> (positive nucleic acid amplification test [NAAT+]/negative enzyme immunoassay [EIA-]) were included.</span></p> <p><b><span>Main outcome measures:</span></b><span> </span><span><span>Treatment for CDI</span></span><span>.</span></p> <p><b><span>Results: </span></b><span><span>CDI treatment was administered in 147 (71%) cases</span></span><span>. In multivariate analysis, </span><span><span>an abdominal computed tomography scan</span></span><span> with signs of colitis (</span><span><span>OR 14.7; 95% CI 1.96-110.8) was the only factor associated with CDI treatment</span></span><span>.</span></p> <p><b><span>Conclusions:</span></b><span> The proportion of NAAT+/EIA- patients who received treatment questions the contribution of the EIA for the detection of toxin A/B after NAAT to limit </span><span><span>overtreatment</span></span><span>. Additional studies are needed to investigate if other factors are associated with the decision to treat.</span></p>