title: Real-time polymerase chain reaction testing for Clostridium difficile reduces isolation time and improves patient management in a small community hospital.
abstract: BACKGROUND
  The impact of a switch from a toxin A/B enzyme immunoassay (EIA) to a polymerase chain reaction (PCR) method for detection of toxigenic Clostridium difficile was assessed for C difficile infection (CDI) rates, patient isolation-days, and CDI-related treatment.
  
  
  METHODS
  A 6-month retrospective study was done on symptomatic patients tested by the toxin A/B EIA and PCR assays. Data on the number of C difficile tests ordered, patient isolation-days, and treatment with metronidazole or vancomycin were collected. CDI rates were reported as cases per 10,000 patient-days, and differences between both groups were compared by χ(2) and Z-test analysis.
  
  
  RESULTS
  The CDI incidence was 11.2 and 12.7/10,000 patient-days in the EIA and PCR test periods, respectively (P = .36). Health care-associated CDI decreased from 4.4 per 10,000 patient-days during EIA testing to 0.9 per 10,000 patient-days during PCR testing (P = .02). A significant decrease in patient isolation-days (P < .00001), tests ordered (P = .002), and metronidazole treatment for patients with a negative C difficile test (P = .02) was observed with PCR testing.
  
  
  CONCLUSIONS
  PCR testing is a viable option for small community hospitals, providing accurate and timely results for patient management and infection control. This can potentially lead to improved outcomes, increased patient satisfaction, and significant hospital cost savings.
authors.affiliation: Infection Prevention Department, Pocono Medical Center, East Stroudsburg, PA 18301, USA. mcatanzaro@pmchealthsystem.org
authors.forename: Mary
authors.initials: M
authors.lastname: Catanzaro
authors.forename: Justin
authors.initials: J
authors.lastname: Cirone
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016360:Clostridioides difficile / Q000235:genetics / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D006764:Hospitals, Community; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D025202:Molecular Diagnostic Techniques / Q000379:methods*; D010356:Patient Isolation / Q000706:statistics & numerical data; D060888:Real-Time Polymerase Chain Reaction / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014640:Vancomycin / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D008795:Metronidazole; D014640:Vancomycin