Infection Control & Hospital Epidemiology


Table 1. Survey Demographics of 196 Respondents and 149 Nonrespondents Demographic


Respondents (n = 196), No. (%) Practice locationa


United States (per Census Bureau Division) New England


Mid Atlantic


East North Central West North Central South Atlantic


East South Central West South Central Mountain Pacific Canada


Years since completing fellowship trainingb


<5 5–14


15–24 ≥25


Employmentc Hospital/clinic


Private group or practice University


Federal/state government or military


Primary hospital typea University hospital


Nonuniversity teaching hospital


Community hospital City/county hospital


Department of Defense or other hospital


Children’s hospital typea


Freestanding children’s hospital


Children’s hospital within an adult hospital


Pediatric ward within an adult hospital


None of the above


Hospital beds, no.b <200


200–350 351–450 451–600 >600


a0.3 < P < 0.4. b0.5 < P < 0.6. c0.8 < P < 0.9.


111 (57) 62 (32) 21 (11) 2 (1)


49 (25) 76 (39) 14 (7)


38 (19) 19 (10)


72 (48) 52 (35) 23 (15) 2 (1)


39 (26) 47 (32) 15 (10) 28 (19) 20 (13)


50 (26) 64 (33) 43 (22) 39 (20)


59 (30) 17 (9)


117 (60) 3 (2)


122 (62) 54 (28)


15 (8) 2 (1) 3 (2)


35 (23) 56 (38) 25 (17) 33 (22)


42 (28) 11 (7)


92 (62) 4 (3)


94 (63) 38 (26)


8 (5) 6 (4) 3 (2)


Non-respondents (n = 149), No. (%)


277


Table 2. Clostridium difficile Testing Strategies at the Institutions of 159 Survey Respondents


Testing Strategy —


Single test NAAT


— 7 (4)


29 (15) 35 (18) 17 (9)


31 (16) 12 (6) 11 (6) 15 (8)


36 (18) 3 (2)


10 (7)


18 (12) 16 (11) 11 (7)


26 (17) 12 (8) 11 (7) 6 (4)


36 (24) 3 (2)


EIA detects only C. difficile


Multiplex PCR panel of multiple gastrointestinal pathogens


for toxin only Combined EIA for GDH and toxin


Toxigenic culture (C. difficile culture followed by detection of toxins)


Multi-step algorithm


GDH EIA followed by cell cytotoxicity neutralization assay or toxin EIA (if GDH positive)


GDH EIA followed by NAAT (if GDH positive) NAAT followed by toxin EIA (if NAAT positive)


Combined GDH/toxin EIA followed by NAAT for discordant results (GDH-positive, toxin-negative stools)


Combinations of the above single test or multistep algorithms


Multiplex PCR panel plus NAAT


Multiplex PCR panel plus GDH/toxin EIA followed by NAAT for discordant results


11 other combinations of testing were each selected by 1 or 2 respondents


21 (13) 6 (4)


13 (8)


Note. NAAT, nucleic acid amplification test; PCR, polymerase chain reaction; EIA, enzyme immunoassay; GDH, glutamate dehydrogenase.


strategies for minimizing NAAT testing of patients with low like- lihood of CDI, such as rejection of formed stools and/or stools from infants and/or young children. The objective of this survey was to determine the prevalence of CDI diagnostic practices in the United States as they relate to avoiding detection of asympto- matic carriage in children.


Methods


An 11-question survey (see Supplemental Materials online) was developed to explore current CDI diagnostic practices for pediatric patients and to determine whether any pediatric patient popula- tions were tested for asymptomatic carriage of C. difficile. The survey was pilot-tested among a group of Emerging Infections Network (EIN) members and pediatric infectious diseases (PID) providers. The EIN, a provider-based emerging infections sentinel network through the Infectious Diseases Society of America (IDSA), distributed the survey to all 362 PID physician members in the United States and Canada via e-mail or facsimile in January 2018. Two reminders were sent to nonrespondents. A denomina- tor of 345 active PID EIN members who had ever responded to an EIN survey was used to the calculate response rate, a standard methodology that has been used in previous EIN surveys.3 Members who were not aware of their institutional policies for test- ing and management of CDI were allowed to opt out of the survey either online or by e-mail. Respondents were not required to answer every question; thus, denominators for individual items vary. Proportions were compared by χ2 test using Stata version 12.1 software (StataCorp, College Station, TX). A 2-sided P <.05 was considered statistically significant.


1 (1)


8 (5) 5 (3)


27 (17) No. (%)


63 (40) 3 (2)


4 (3) 8 (5) 0


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