References | [12] | [15] | [16] |
---|---|---|---|
Organizations | European Society of Clinical Microbiology and Infectious Diseases (ESCMID) | Infectious Diseases Society of America (IDSA), Society for Healthcare Epidemiology of America (SHEA) | American College of G astroenterology (ACG) |
Diagnosis of CDI | Clinical signs and symptoms in combination with laboratory tests | The presence of symptoms and either a laboratory test positive, or colonoscopic or histopathologic findings revealing pseudomembranous colitis | No single test can replace clinical acumen Diagnosis and decision to treat are clinical issues |
Indications for CDI testing | Age ≥ 3 years Unformed stool samples Formed stool samples should not be tested (except in the case of paralytic ileus) In patients suspected of ileus, a rectal swab can be used. | Patients with unexplained and newonset, with three or more unformed stools in 24 hours Refuse a specimen from a patient receiving laxatives. | Individuals with symptoms suggestive of active CDI (three or more unformed stools in 24 hours) Exception: formed stool may be tested for infection control purposes, documentation of colonization, etc. Rectal swabs for PCR may be useful for patients with an ileus |
Recommendations for stand-alone testing | Not recommended | NAAT alone can be tested if there are pre-agreed institutional criteria for patient stool submission | No single test is suitable to be used as a stand-alone test |
Recommendations for multistep algorithm | 2-step algorithm NAAT or GDH → Toxin AB → TC or NAAT (Optional) GDH and Toxin AB → TC or NAAT (Optional) | Stool toxin test as part of multistep algorithm GDH plus toxin GDH plus toxin, arbitrated by NAAT NAAT plus toxin | Algorithms should include both a highly sensitive and a highly specific testing modality 2-step algorithm GDH or NAAT → Toxin A/B |
Branch | No. positive / No. examined (%) | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
2011 | 2016 | 2017 | 2018 | 2019 | 2020 | |||||
Western Seoul | 48/7,892 (0.6) | 41/6,440 (0.6) | 18/4,674 (0.4) | 15/4,462 (0.3) | 6/4,396 (0.1) | 7/3,941 (0.2) | ||||
Eastern Seoul | 17/6,736 (0.3) | 16/3,546 (0.5) | 14/5,508 (0.3) | 21/6,113 (0.3) | 11/6,929 (0.2) | 1/1,956 (0.1) | ||||
Southern Seoul | 13/6,381 (0.2) | 6/4,587 (0.1) | 6/4,197 (0.1) | 8/3,976 (0.2) | 6/4,937 (0.1) | 4/4,693 (0.1) | ||||
Busan | 735/41,225 (1.8) | 994/49,467 (2.0) | 865/49,047 (1.8) | 741/41,817 (1.8) | 545/44,264 (1.2) | 440/43,745 (1.0) | ||||
Daegu | 18/9,499 (0.2) | 31/8,728 (0.4) | 63/12,227 (0.5) | 39/9,378 (0.4) | 39/6,809 (0.6) | 33/9,379 (0.4) | ||||
Incheon | 0/2,566 (0.0) | 8/2,355 (0.3) | 29/3,086 (0.9) | 30/2,522 (1.2) | 22/2,098 (1.1) | 22/3,259 (0.7) | ||||
Ulsan | 523/15,207 (3.4) | 269/10,923 (2.5) | 203/11,339 (1.8) | 190/7,251 (2.6) | 107/7,280 (1.5) | 51/3,477 (1.5) | ||||
Gyeonggi | 35/7,540 (0.5) | 28/5,716 (0.5) | 17/7,106 (0.2) | 20/5,257 (0.4) | 11/3,673 (0.3) | 7/3,270 (0.2) | ||||
Gangwon | 0/718 (0.0) | 0/270 (0.0) | 3/469 (0.6) | 2/1,195 (0.2) | 0/2,023 (0.0) | 0/1,729 (0.0) | ||||
Chungbuk | 0/2,072 (0.0) | 0/1,832 (0.0) | 17/2,859 (0.6) | 8/3,350 (0.2) | 11/3,032 (0.4) | 9/1,831 (0.5) | ||||
Chungnam | 18/4,536 (0.4) | 40/4,109 (1.0) | 16/4,605 (0.4) | 13/4,735 (0.3) | 20/5,446 (0.4) | 24/11,331 (0.2) | ||||
Jeonbuk | 29/6,643 (0.4) | 3/3,805 (0.1) | 12/3,766 (0.3) | 15/3,606 (0.4) | 35/5,129 (0.7) | 24/4,599 (0.5) | ||||
Jeonnam | 77/5,897 (1.3) | 89/5,294 (1.7) | 78/5,762 (1.4) | 97/5,563 (1.7) | 84/6,964 (1.2) | 90/7,503 (1.2) | ||||
Gyeongbuk | 136/8,743 (1.6) | 130/6,428 (2.0) | 113/7,315 (1.5) | 121/6,508 (1.9) | 103/6,770 (1.5) | 37/5,252 (0.7) | ||||
Gyeongnam | 811/16,635 (4.9) | 750/14,909 (5.0) | 676/15,056 (4.5) | 711/14,721 (4.8) | 782/20,119 (3.9) | 538/20,819 (2.6) | ||||
Jeju | 0/1,659 (0.0) | 0/1,896 (0.0) | 0/2,156 (0.0) | 0/1,173 (0.0) | 0/826 (0.0) | 0/944 (0.0) | ||||
Total | 2,460/143,949 (1.7) | 2,405/130,305 (1.9) | 2,130/139,172 (1.5) | 2,031/121,627 (1.7) | 1,782/130,695 (1.4) | 1287/127,728 (1.0) |
References | [12] | [15] | [16] |
---|---|---|---|
Organizations | European Society of Clinical Microbiology and Infectious Diseases (ESCMID) | Infectious Diseases Society of America (IDSA), Society for Healthcare Epidemiology of America (SHEA) | American College of G astroenterology (ACG) |
Diagnosis of CDI | Clinical signs and symptoms in combination with laboratory tests | The presence of symptoms and either a laboratory test positive, or colonoscopic or histopathologic findings revealing pseudomembranous colitis | No single test can replace clinical acumen Diagnosis and decision to treat are clinical issues |
Indications for CDI testing | Age ≥ 3 years Unformed stool samples Formed stool samples should not be tested (except in the case of paralytic ileus) In patients suspected of ileus, a rectal swab can be used. | Patients with unexplained and newonset, with three or more unformed stools in 24 hours Refuse a specimen from a patient receiving laxatives. | Individuals with symptoms suggestive of active CDI (three or more unformed stools in 24 hours) Exception: formed stool may be tested for infection control purposes, documentation of colonization, etc. Rectal swabs for PCR may be useful for patients with an ileus |
Recommendations for stand-alone testing | Not recommended | NAAT alone can be tested if there are pre-agreed institutional criteria for patient stool submission | No single test is suitable to be used as a stand-alone test |
Recommendations for multistep algorithm | 2-step algorithm NAAT or GDH → Toxin AB → TC or NAAT (Optional) GDH and Toxin AB → TC or NAAT (Optional) | Stool toxin test as part of multistep algorithm GDH plus toxin GDH plus toxin, arbitrated by NAAT NAAT plus toxin | Algorithms should include both a highly sensitive and a highly specific testing modality 2-step algorithm GDH or NAAT → Toxin A/B |
Branch | No. positive / No. examined (%) | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
2011 | 2016 | 2017 | 2018 | 2019 | 2020 | |||||
Western Seoul | 48/7,892 (0.6) | 41/6,440 (0.6) | 18/4,674 (0.4) | 15/4,462 (0.3) | 6/4,396 (0.1) | 7/3,941 (0.2) | ||||
Eastern Seoul | 17/6,736 (0.3) | 16/3,546 (0.5) | 14/5,508 (0.3) | 21/6,113 (0.3) | 11/6,929 (0.2) | 1/1,956 (0.1) | ||||
Southern Seoul | 13/6,381 (0.2) | 6/4,587 (0.1) | 6/4,197 (0.1) | 8/3,976 (0.2) | 6/4,937 (0.1) | 4/4,693 (0.1) | ||||
Busan | 735/41,225 (1.8) | 994/49,467 (2.0) | 865/49,047 (1.8) | 741/41,817 (1.8) | 545/44,264 (1.2) | 440/43,745 (1.0) | ||||
Daegu | 18/9,499 (0.2) | 31/8,728 (0.4) | 63/12,227 (0.5) | 39/9,378 (0.4) | 39/6,809 (0.6) | 33/9,379 (0.4) | ||||
Incheon | 0/2,566 (0.0) | 8/2,355 (0.3) | 29/3,086 (0.9) | 30/2,522 (1.2) | 22/2,098 (1.1) | 22/3,259 (0.7) | ||||
Ulsan | 523/15,207 (3.4) | 269/10,923 (2.5) | 203/11,339 (1.8) | 190/7,251 (2.6) | 107/7,280 (1.5) | 51/3,477 (1.5) | ||||
Gyeonggi | 35/7,540 (0.5) | 28/5,716 (0.5) | 17/7,106 (0.2) | 20/5,257 (0.4) | 11/3,673 (0.3) | 7/3,270 (0.2) | ||||
Gangwon | 0/718 (0.0) | 0/270 (0.0) | 3/469 (0.6) | 2/1,195 (0.2) | 0/2,023 (0.0) | 0/1,729 (0.0) | ||||
Chungbuk | 0/2,072 (0.0) | 0/1,832 (0.0) | 17/2,859 (0.6) | 8/3,350 (0.2) | 11/3,032 (0.4) | 9/1,831 (0.5) | ||||
Chungnam | 18/4,536 (0.4) | 40/4,109 (1.0) | 16/4,605 (0.4) | 13/4,735 (0.3) | 20/5,446 (0.4) | 24/11,331 (0.2) | ||||
Jeonbuk | 29/6,643 (0.4) | 3/3,805 (0.1) | 12/3,766 (0.3) | 15/3,606 (0.4) | 35/5,129 (0.7) | 24/4,599 (0.5) | ||||
Jeonnam | 77/5,897 (1.3) | 89/5,294 (1.7) | 78/5,762 (1.4) | 97/5,563 (1.7) | 84/6,964 (1.2) | 90/7,503 (1.2) | ||||
Gyeongbuk | 136/8,743 (1.6) | 130/6,428 (2.0) | 113/7,315 (1.5) | 121/6,508 (1.9) | 103/6,770 (1.5) | 37/5,252 (0.7) | ||||
Gyeongnam | 811/16,635 (4.9) | 750/14,909 (5.0) | 676/15,056 (4.5) | 711/14,721 (4.8) | 782/20,119 (3.9) | 538/20,819 (2.6) | ||||
Jeju | 0/1,659 (0.0) | 0/1,896 (0.0) | 0/2,156 (0.0) | 0/1,173 (0.0) | 0/826 (0.0) | 0/944 (0.0) | ||||
Total | 2,460/143,949 (1.7) | 2,405/130,305 (1.9) | 2,130/139,172 (1.5) | 2,031/121,627 (1.7) | 1,782/130,695 (1.4) | 1287/127,728 (1.0) |
References | [12] | [15] | [16] |
---|---|---|---|
Organizations | European Society of Clinical Microbiology and Infectious Diseases (ESCMID) | Infectious Diseases Society of America (IDSA), Society for Healthcare Epidemiology of America (SHEA) | American College of G astroenterology (ACG) |
Diagnosis of CDI | Clinical signs and symptoms in combination with laboratory tests | The presence of symptoms and either a laboratory test positive, or colonoscopic or histopathologic findings revealing pseudomembranous colitis | No single test can replace clinical acumen Diagnosis and decision to treat are clinical issues |
Indications for CDI testing | Age ≥ 3 years Unformed stool samples Formed stool samples should not be tested (except in the case of paralytic ileus) In patients suspected of ileus, a rectal swab can be used. | Patients with unexplained and newonset, with three or more unformed stools in 24 hours Refuse a specimen from a patient receiving laxatives. | Individuals with symptoms suggestive of active CDI (three or more unformed stools in 24 hours) Exception: formed stool may be tested for infection control purposes, documentation of colonization, etc. Rectal swabs for PCR may be useful for patients with an ileus |
Recommendations for stand-alone testing | Not recommended | NAAT alone can be tested if there are pre-agreed institutional criteria for patient stool submission | No single test is suitable to be used as a stand-alone test |
Recommendations for multistep algorithm | 2-step algorithm NAAT or GDH → Toxin AB → TC or NAAT (Optional) GDH and Toxin AB → TC or NAAT (Optional) | Stool toxin test as part of multistep algorithm GDH plus toxin GDH plus toxin, arbitrated by NAAT NAAT plus toxin | Algorithms should include both a highly sensitive and a highly specific testing modality 2-step algorithm GDH or NAAT → Toxin A/B |
Branch | No. positive / No. examined (%) | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
2011 | 2016 | 2017 | 2018 | 2019 | 2020 | |||||
Western Seoul | 48/7,892 (0.6) | 41/6,440 (0.6) | 18/4,674 (0.4) | 15/4,462 (0.3) | 6/4,396 (0.1) | 7/3,941 (0.2) | ||||
Eastern Seoul | 17/6,736 (0.3) | 16/3,546 (0.5) | 14/5,508 (0.3) | 21/6,113 (0.3) | 11/6,929 (0.2) | 1/1,956 (0.1) | ||||
Southern Seoul | 13/6,381 (0.2) | 6/4,587 (0.1) | 6/4,197 (0.1) | 8/3,976 (0.2) | 6/4,937 (0.1) | 4/4,693 (0.1) | ||||
Busan | 735/41,225 (1.8) | 994/49,467 (2.0) | 865/49,047 (1.8) | 741/41,817 (1.8) | 545/44,264 (1.2) | 440/43,745 (1.0) | ||||
Daegu | 18/9,499 (0.2) | 31/8,728 (0.4) | 63/12,227 (0.5) | 39/9,378 (0.4) | 39/6,809 (0.6) | 33/9,379 (0.4) | ||||
Incheon | 0/2,566 (0.0) | 8/2,355 (0.3) | 29/3,086 (0.9) | 30/2,522 (1.2) | 22/2,098 (1.1) | 22/3,259 (0.7) | ||||
Ulsan | 523/15,207 (3.4) | 269/10,923 (2.5) | 203/11,339 (1.8) | 190/7,251 (2.6) | 107/7,280 (1.5) | 51/3,477 (1.5) | ||||
Gyeonggi | 35/7,540 (0.5) | 28/5,716 (0.5) | 17/7,106 (0.2) | 20/5,257 (0.4) | 11/3,673 (0.3) | 7/3,270 (0.2) | ||||
Gangwon | 0/718 (0.0) | 0/270 (0.0) | 3/469 (0.6) | 2/1,195 (0.2) | 0/2,023 (0.0) | 0/1,729 (0.0) | ||||
Chungbuk | 0/2,072 (0.0) | 0/1,832 (0.0) | 17/2,859 (0.6) | 8/3,350 (0.2) | 11/3,032 (0.4) | 9/1,831 (0.5) | ||||
Chungnam | 18/4,536 (0.4) | 40/4,109 (1.0) | 16/4,605 (0.4) | 13/4,735 (0.3) | 20/5,446 (0.4) | 24/11,331 (0.2) | ||||
Jeonbuk | 29/6,643 (0.4) | 3/3,805 (0.1) | 12/3,766 (0.3) | 15/3,606 (0.4) | 35/5,129 (0.7) | 24/4,599 (0.5) | ||||
Jeonnam | 77/5,897 (1.3) | 89/5,294 (1.7) | 78/5,762 (1.4) | 97/5,563 (1.7) | 84/6,964 (1.2) | 90/7,503 (1.2) | ||||
Gyeongbuk | 136/8,743 (1.6) | 130/6,428 (2.0) | 113/7,315 (1.5) | 121/6,508 (1.9) | 103/6,770 (1.5) | 37/5,252 (0.7) | ||||
Gyeongnam | 811/16,635 (4.9) | 750/14,909 (5.0) | 676/15,056 (4.5) | 711/14,721 (4.8) | 782/20,119 (3.9) | 538/20,819 (2.6) | ||||
Jeju | 0/1,659 (0.0) | 0/1,896 (0.0) | 0/2,156 (0.0) | 0/1,173 (0.0) | 0/826 (0.0) | 0/944 (0.0) | ||||
Total | 2,460/143,949 (1.7) | 2,405/130,305 (1.9) | 2,130/139,172 (1.5) | 2,031/121,627 (1.7) | 1,782/130,695 (1.4) | 1287/127,728 (1.0) |