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Please use this identifier to cite or link to this item: http://hdl.handle.net/10564/4030

Title: The impact of toxigenic culture on antimicrobial prescriptions for Clostridioides difficile infection: The role of diagnostic stewardship.
Other Titles: 毒素培養がClostridioides difficile感染症の抗菌薬処方に与える影響 : diagnostic stewardshipの役割
Authors: Sang-Tae, Lee
Tanaka, Shinobu
Yamazaki, Masaharu
Inoue, Takashi
Kasahara, Kei
Keywords: Clostridioides difficile infection (CDI)
toxigenic culture
diagnostic stewardship
Issue Date: 30-Nov-2021
Publisher: 奈良医学会
Citation: Journal of Nara Medical Association Vol.72 No.4,5,6 p.43-50 (2021.11)
Abstract: Introduction : Toxigenic culture has been recommended as a sensitivity enhancement option for testing Clostridioides difficile infections (CDI). However, no studies have evaluated whether toxigenic culture impacts clinical decisions such as CDI treatment. Methods : At Nara Medical University Hospital, simultaneous testing of glutamate dehydrogenase antigen (A) and toxin A/B (T) by immunochromatography has been conducted since November 2013. Furthermore, toxigenic culture (C) has been adopted since April 2018. Therefore, patients tested for CD were divided into two groups: pre-period from April 2014 to March 2018 and post-period from April 2018 to March 2021. Patient data were retrospectively examined. Results : The study included 1262 and 1023 cases in the pre- and post-periods, respectively. A significant reduction in A+T+ cases could be observed with 64 (5.1 %) and 28 (2.7%) in the pre- and post-periods (P = 0.005), respectively. Of the 104 A+T- cases undergoing toxigenic culture in the post-period, 54 (51.9 %) were A+T-C+. The antimicrobial administration ratio for the A+T-C+ cases (68.5 %) was lower than that for the A+T+ patients (90.6 and 82.1 %, P = 0.014 and P = 0.417, in the pre- and post-periods, respectively), and was not significantly different from that of the A+T-patients (64.2 and 64.1 % in the pre- and post-periods, respectively) or from that of the A+ T-C-patients (64 %). Conclusion : This study showed that toxigenic culture does not necessarily affect the antibiotic administration ratio or duration. A coordinated approach under diagnostic stewardship for improved reporting and interpretation of toxigenic cultures would be necessary.
Description: 博士(医学)・乙第1525号・令和4年3月15日
URI: http://hdl.handle.net/10564/4030
ISSN: 13450069
Academic Degrees and number: 24601B1525
Degree-granting date: 2022-03-15
Degree name: 博士(医学)
Degree-granting institutions: 奈良県立医科大学
Appears in Collections:Vol.72 No.4,5,6

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