Two-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 two-step testing may result in adverse outcomes if C. difficile is under-diagnosed.
The primary objective was to assess the impact of two-step testing on reported incidence of hospital-onset CDI (HO-CDI). As secondary objectives, Dr. Turner and team assessed the impact of two-step testing on C. difficile-specific antibiotic use and colectomy rates as proxies for harm from under-diagnosis or delayed treatment.
Two-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 under-diagnosis 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.
Check out the full article from Dr. Turner and the rest of his team in Clinical Infectious Diseases.