title: Outcomes in patients tested for Clostridium difficile toxins.
abstract: Clostridium difficile testing is shifting from toxin detection to C. difficile detection. Yet, up to 60% of patients with C. difficile by culture test negative for toxins and it is unclear whether they are infected or carriers. We reviewed medical records for 7046 inpatients with a C. difficile toxin test from 2005 to 2009 to determine the duration of diarrhea and rate of complications and mortality among toxin-positive (toxin+) and toxin- patients. Overall, toxin- patients had less severe diarrhea, fewer diarrhea days, and lower mortality (P < 0.001, all comparisons) than toxin+ patients. One toxin- patient (n = 1/6121; 0.02%) was diagnosed with pseudomembranous colitis, but there were no complications such as megacolon or colectomy for fulminant CDI among toxin- patients. These data suggest that C. difficile-attributable complications are rare among patients testing negative for C. difficile toxins. More studies are needed to evaluate the clinical significance of C. difficile detection in toxin- patients.
authors.affiliation: Department of Pathology and Laboratory Medicine, UC Davis Medical Center, Sacramento, CA 95817, USA. christopher.polage@ucdmc.ucdavis.edu
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Polage
authors.forename: David L
authors.initials: DL
authors.lastname: Chin
authors.forename: Jhansi L
authors.initials: JL
authors.lastname: Leslie
authors.forename: Jevon
authors.initials: J
authors.lastname: Tang
authors.forename: Stuart H
authors.initials: SH
authors.lastname: Cohen
authors.forename: Jay V
authors.initials: JV
authors.lastname: Solnick
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001427:Bacterial Toxins / Q000032:analysis*; D002648:Child; D002675:Child, Preschool; D016360:Clostridioides difficile / Q000302:isolation & purification* / Q000472:pathogenicity; D003015:Clostridium Infections / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology; D003967:Diarrhea / Q000150:complications / Q000382:microbiology* / Q000401:mortality / Q000473:pathology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis; D055815:Young Adult
chemical_list: D001427:Bacterial Toxins