title: Use of a Perianal Swab Compared With a Stool Sample to Detect Symptomatic Clostridium difficile Infection.
abstract: OBJECTIVE To evaluate the use of a perianal swab to detect CDI. METHODS A perianal swab was collected from each inpatient with a positive stool sample for C. difficile (by polymerase chain reaction [PCR] test) and was tested for C. difficile by PCR and by culture. The variables evaluated included demographics, CDI severity, bathing before perianal swab collection, hours between stool sample and perianal swab, cycle threshold (Ct) to PCR positivity, and doses of CDI treatment before stool sample and before perianal swab. RESULTS Of 83 perianal swabs, 59 (71.1%) tested positive for C. difficile by PCR when perianal swabs were collected an average of 21 hours after the stool sample. Compared with the respective stool sample, the perianal sample was less likely to grow C. difficile (P=.005) and had a higher PCR Ct (P<.001). A direct, significant but weak correlation was detected between the Ct for a positive perianal sample and the respective stool sample (r=0.36; P=.006). An inverse dose relationship was detected between PCR positivity and CDI treatment doses before perianal swab collection (P=.27). CONCLUSION Perianal swabs are a simple method to detect C. difficile tcdB gene by PCR, with a sensitivity of 71%. These data were limited because stool samples and perianal swabs were not collected simultaneously. Compared with stool samples, the perianal Ct values and culture results were consistent with a lower bacterial load on the perianal sample due to the receipt of more CDI treatment before collection or unknown factors affecting perianal skin colonization. Infect Control Hosp Epidemiol 2017;38:658-662.
authors.affiliation: 1Division of Infectious Diseases,Department of Medicine,New York Medical College,Valhalla,New York.
authors.forename: Marisa A
authors.initials: MA
authors.lastname: Montecalvo
authors.affiliation: 1Division of Infectious Diseases,Department of Medicine,New York Medical College,Valhalla,New York.
authors.forename: Emnet
authors.initials: E
authors.lastname: Sisay
authors.affiliation: 1Division of Infectious Diseases,Department of Medicine,New York Medical College,Valhalla,New York.
authors.forename: Donna
authors.initials: D
authors.lastname: McKenna
authors.affiliation: 2Department of Pathology,New York Medical College,Valhalla,New York.
authors.forename: Guiqing
authors.initials: G
authors.lastname: Wang
authors.affiliation: 3Office of Research,Baystate Medical Center,Springfield,Massachusetts.
authors.forename: Paul
authors.initials: P
authors.lastname: Visintainer
authors.affiliation: 1Division of Infectious Diseases,Department of Medicine,New York Medical College,Valhalla,New York.
authors.forename: Gary P
authors.initials: GP
authors.lastname: Wormser
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000382:microbiology*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D058491:Bacterial Load; D001426:Bacterial Proteins / Q000235:genetics; D001427:Bacterial Toxins / Q000235:genetics; D016360:Clostridioides difficile / Q000235:genetics / Q000254:growth & development / Q000302:isolation & purification*; D004269:DNA, Bacterial / Q000032:analysis; D004761:Enterocolitis, Pseudomembranous / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D005243:Feces / Q000382:microbiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013997:Time Factors; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D001427:Bacterial Toxins; D004269:DNA, Bacterial; C031815:toxB protein, Clostridium difficile