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J Gen Intern Med. 1997 Jan;12(1):57-62.

Predicting Clostridium difficile stool cytotoxin results in hospitalized patients with diarrhea.

Author information

1
Division of Clinical Decision Making, New England Medical Center and Tufts University School of Medicine, Boston, Mass, USA.

Abstract

OBJECTIVE:

To validate a model for the prediction of Clostridium difficile cytotoxin assay results, and to identify a subgroup of patients with a very low likelihood of C. difficile-associated disease in whom the yield of routine cytotoxin testing is low.

DESIGN:

Prospective cohort study. Relevant clinical symptoms, signs, and antibiotic exposure were recorded before reporting of assay results. Each predictor was assigned a score based on regression coefficients, and patients were stratified according to their total score.

SETTING:

Two urban, tertiary care, university hospitals.

PATIENTS:

A total of 609 consecutive adult inpatients who received testing for C. difficile cytotoxin during a 3-month period in 1994.

MEASUREMENTS AND MAIN RESULTS:

The prevalence of positive cytotoxin assays was 8% in the validation set, compared with 14% in the derivation set. Defining patients without both prior antibiotic use and at least one symptom predictor (significant diarrhea or abdominal pain) as a low-risk subgroup, the misclassification rate was 2.8% (5/177) for assay results; of the five misclassified cases patients, only one was judged to have C. difficile-associated disease. Use of this rule to identify low-risk patients could have potentially averted 29% of all cytotoxin assays.

CONCLUSIONS:

Patients without a history of antibiotic use and either significant diarrhea or abdominal pain are unlikely to have positive C. difficile cytotoxin assays and may not require cytotoxin testing.

PMID:
9034947
PMCID:
PMC1497057
[Indexed for MEDLINE]
Free PMC Article
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