!!
Toxin Enzyme #Immunoassays Detect #Clostridioides difficile Infection with Greater Severity and Higher Recurrence Rates

https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciz009/5274659

Few data suggest Clostridioides difficile infections (CDI) detected by toxin enzyme immunoassays (EIA) are more severe and have worse outcomes than those detected by nucleic acid amplification tests (NAAT) only. We compared toxin-positive and NAAT-positive only CDI across geographically-diverse sites

Of 4878 cases, 2160 (44.3%) were toxin-positive and 2718 (55.7%) were NAAT-positive only. More toxin-positive than NAAT-positive only cases were aged ≥65 years (48.2% vs 38.0%; P<0.0001), had ≥3 unformed stool for ≥1 day (43.9% vs 36.6%; P<0.0001), and had white blood cells ≥15,000/µl (31.4% versus 21.4%; P<0.0001). In multivariable analysis, toxin-positivity was associated with recurrence (adjusted odds ratio [aOR]: 1.89, 95% CI: 1.61-2.23), but not with CDI-related complications (aOR: 0.91, 95% CI: 0.67-1.23) or 30-day mortality (aOR: 0.95; 95% CI: 0.73-1.24).

Conclusions
Toxin-positive CDI is more severe, but there were no differences in adjusted CDI-related complication and mortality rates between toxin-positive and NAAT-positive only CDI that were detected by an algorithm that utilized an initial GDH screening test.