08 Sep Molecular Test For C. difficile Leads To Overdiagnosis

MedicalResearch.com Interview with:
Christopher R. Polage, M. D.
Associate Professor of Pathology and Infectious Diseases
University of California, Davis School of Medicine
Medical Director, Microbiology Laboratory and SARC
UC Davis Health System

Medical Research: What is the background for this study?

Dr. Polage: Clostridium difficile is a frequent cause of diarrhea and infection in U.S. hospitals but common diagnostic tests often disagree about which patients are infected or need treatment. We compared clinical symptoms and outcomes in hospitalized patients with different C. difficile test results to determine which type of test (molecular or PCR test versus toxin test) was the better predictor of need for treatment and disease.

Medical Research: What are the main findings?

Dr. Polage: Twice as many patients were positive by the molecular test versus the conventional toxin test. However, patients with a positive molecular test only had a shorter duration of symptoms than patients with toxins, and outcomes that were similar to patients withoutC. difficile by all test methods. Virtually all traditional complications of C. difficile infection occurred in patients with a positive toxin test; none occurred in patients with a positive molecular test only, despite little or no treatment.

Medical Research: What should clinicians and patients take away from your report?

Dr. Polage: Molecular C. difficile tests are not specific for clinical disease and should not be used as the sole criteria for diagnostic and treatment decisions. Most patients with diarrhea and a positive C. difficile molecular test do not need treatment unless toxin tests are also positive. Laboratories and diagnostic criteria should include a toxin test to define clinically significant C. difficile infection and need for treatment.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Polage: Future studies should aim to determine how often patients with low levels of toxin, not detected by current diagnostic toxin tests, experience complications of C. difficile infection. Better tests are needed to reliably distinguish patients with C. difficile infection from patients with C. difficile colonization and other causes of diarrheal symptoms.

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Christopher R. Polage, M. D. (2015). Molecular Test For C. difficile Leads To Overdiagnosis 

Last Updated on September 8, 2015 by Marie Benz MD FAAD