title: A detection dog to identify patients with Clostridium difficile infection during a hospital outbreak.
abstract: OBJECTIVE
  Early and rapid identification of Clostridium difficile infections (CDI) is important to prevent transmission. In this study we assessed the diagnostic accuracy of a trained detection dog for detecting CDI cases on hospital wards in an outbreak setting.
  
  
  METHODS
  During a CDI outbreak in a large Dutch university hospital, we screened affected hospital wards repeatedly with a trained detection dog. The dog's response was compared to the clinical diagnosis, supported by laboratory results.
  
  
  RESULTS
  During a total of 9 hospital visits, the dog performed 651 screenings involving 371 participants. The dog correctly identified 12 out of 14 CDI cases [sensitivity 86% (95% confidence interval (CI): 56-97%)] and 346 out of 357 CDI negative participants [specificity of 97% (95% CI: 94-98%)]. Interestingly, of the 11 CDI negative participants that were 'falsely' indicated by the dog as positive, 2 (18%) did actually developed CDI during the 3 months of follow-up after the detection period; compared to only 12 of the 346 participants (3.5%) that the dog identified as C. difficile negative (p = 0.06).
  
  
  CONCLUSIONS
  A trained detection dog can accurately detect CDI in hospitalized patients during an outbreak. A (repeated) positive dog response is a strong indication of a CDI episode coming, be it the next day or possibly up to a month.
authors: Department of Internal Medicine, VU University Medical Centre, PO BOX 7057, 1007 MB Amsterdam, Netherlands. Electronic address: m.bomers@vumc.nl.
authors: Marije K
authors: MK
authors: Bomers
authors: Department of Internal Medicine, VU University Medical Centre, PO BOX 7057, 1007 MB Amsterdam, Netherlands.
authors: Michiel A
authors: MA
authors: van Agtmael
authors: Animal Behaviour& Cognition, Scent Detection Research and Academy HL & Honden, Jan van Wallendalplein 7, 1135 WN Edam, Netherlands.
authors: Hotsche
authors: H
authors: Luik
authors: Department of Medical Microbiology and Infection Control, VU University Medical Centre, PO BOX 7057, 1007 MB Amsterdam, Netherlands.
authors: Christina M J E
authors: CM
authors: Vandenbroucke-Grauls
authors: Department of Internal Medicine, VU University Medical Centre, PO BOX 7057, 1007 MB Amsterdam, Netherlands.
authors: Yvo M
authors: YM
authors: Smulders
mesh_terms: D000328:Adult; D000368:Aged; D000818:Animals; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000175:diagnosis* / Q000453:epidemiology; D003428:Cross Infection / Q000175:diagnosis* / Q000453:epidemiology; D004196:Disease Outbreaks; D004285:Dogs; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity
keywords: Clostridium difficile; Detection dog; Outbreak containment; Scent detection; Sensitivity and specificity