{"doi":"10.1017/ice.2023.262","title":"Potential underreporting of treated patients using a <i>Clostridioides difficile</i> testing algorithm that screens with a nucleic acid amplification test","abstract":"OBJECTIVE: infection (CDI) using a 2-step algorithm with a nucleic acid amplification test (NAAT) followed by toxin assay are not reported to the National Healthcare Safety Network as a laboratory-identified CDI event if they are NAAT positive (+)/toxin negative (-). We compared NAAT+/toxin- and NAAT+/toxin+ patients and identified factors associated with CDI treatment among NAAT+/toxin- patients. DESIGN: Retrospective observational study. SETTING: The study was conducted across 36 laboratories at 5 Emerging Infections Program sites. PATIENTS: We defined a CDI case as a positive test detected by this 2-step algorithm during 2018-2020 in a patient aged ≥1 year with no positive test in the previous 8 weeks. METHODS: We used multivariable logistic regression to compare CDI-related complications and recurrence between NAAT+/toxin- and NAAT+/toxin+ cases. We used a mixed-effects logistic model to identify factors associated with treatment in NAAT+/toxin- cases. RESULTS: < .0001). NAAT+/toxin- status was protective for recurrence (adjusted odds ratio [aOR], 0.65; 95% CI, 0.55-0.77) but not CDI-related complications (aOR, 1.05; 95% CI, 0.87-1.28). Among NAAT+/toxin- cases, white blood cell count ≥15,000/µL (aOR, 1.87; 95% CI, 1.28-2.74), ≥3 unformed stools for ≥1 day (aOR, 1.90; 95% CI, 1.40-2.59), and diagnosis by a laboratory that provided no or neutral interpretive comments (aOR, 3.23; 95% CI, 2.23-4.68) were predictors of CDI treatment. CONCLUSION: Use of this 2-step algorithm likely results in underreporting of some NAAT+/toxin- cases with clinically relevant CDI. Disease severity and laboratory interpretive comments influence treatment decisions for NAAT+/toxin- cases.","journal":"Infection Control and Hospital Epidemiology","year":2024,"id":439624,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":9,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9632,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2024-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":271489,"name":"Scott K. Fridkin","orcid":"0000-0003-4892-693X","position":1,"is_corresponding":false},{"id":585455,"name":"Dana Goodenough","orcid":"0000-0003-4642-0839","position":2,"is_corresponding":false},{"id":218472,"name":"Lisa G. Winston","orcid":null,"position":3,"is_corresponding":false},{"id":218473,"name":"Helen Johnston","orcid":"0000-0002-7862-5858","position":4,"is_corresponding":false},{"id":748522,"name":"Elizabeth Basiliere","orcid":"0009-0009-0106-2063","position":5,"is_corresponding":false},{"id":218474,"name":"Danyel Olson","orcid":null,"position":6,"is_corresponding":false},{"id":876457,"name":"Christopher Wilson","orcid":"0000-0003-0349-5371","position":7,"is_corresponding":false},{"id":1251355,"name":"Jasmine Watkins","orcid":null,"position":8,"is_corresponding":false},{"id":876456,"name":"Lauren Korhonen","orcid":"0000-0001-6349-929X","position":9,"is_corresponding":false},{"id":218483,"name":"Dale N. Gerding","orcid":"0000-0003-4409-1605","position":10,"is_corresponding":false},{"id":218470,"name":"Alice Guh","orcid":"0000-0002-3141-2089","position":0,"is_corresponding":true}],"reference_count":29,"raw_metadata":null,"created_at":"2026-07-19T02:00:52.633010Z","pmid":"38268440","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}