Background: In recent years the rate of Clostridium difficile infections (CDI) at the Wolfson Medical Center was steady [100 cases per 100,000 hospital days (HD)]. In order to decrease this rate, we employed an infection control program that included immediate contact precautions (CP) of all patients with diarrhea and PCR testing for all diarrheal samples.
Materials/methods: Diarrheal stool samples were collected from symptomatic patients as part of routine clinical care at the Wolfson Medical Center in Israel. Until August 31, 2016 samples were tested by glutamate dehydrogenase (GDH) C. diff Quik-chek complete R (TechlabR) kit. Only equivocal cases (mismatch between the GDH/toxin test) were confirmed by PCR. From September 1st 2016 all diarrheal stool samples were screened only by a PCR-based assay (GeneXpert(®) C. difficile; Cepheid, and all patients with diarrhea were placed in CP with a private toilet from onset of diarrhea (before laboratory confirmation) up to 72 hours after diarrhea stopped.
Results: During a 6-month period from September 2014 to February 2015, 821 patients were tested of which 83 cases were positive (10.1%). During a second 6-month period from September 2015 to February 2016, 919 patients were tested, of which 94 cases were positive (10.2%). During a third 6-month period from September 2016 to February 2017, 872 patients were tested, of which 83 cases were positive (9.5%). The mean age of patients over the three periods was similar. CDI rates were 97, 101 and 97 cases per 100,000 HD, respectfully.
Conclusions: The number of tests performed for CDI over 2014-2017 did not increase. This was also reflected by constant CDI rates. The algorithm used did not affect CDI rates and in our hands there was no significant difference between using a one-step PCR or the two-step method. The turnaround time of both algorithms was 1-3 hours. Altogether, the intervention was not successful in decreasing CDI rates. As performing a one-step PCR for all samples is expensive we recommend using the two step approach. These results should be validated in additional populations as CDI in our hospital was common in elderly patients.