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Communication

Use of PCR Cycle Threshold and Clinical Interventions to Aid in the Management of Pediatric Clostridioides difficile Patients

1
Department of Pathology, Sidra Medicine, Doha P.O. Box 26999, Qatar
2
Department of Pathology and Laboratory Medicine, Weill Cornell Medicine in Qatar, Doha P.O. Box 24144, Qatar
3
Department of Infectious Diseases, Sidra Medicine, Doha P.O. Box 26999, Qatar
4
Center for Global Health and Infectious Disease Research, University of South Florida, Tampa, FL 33612, USA
*
Author to whom correspondence should be addressed.
Microorganisms 2024, 12(6), 1181; https://doi.org/10.3390/microorganisms12061181
Submission received: 16 May 2024 / Revised: 3 June 2024 / Accepted: 5 June 2024 / Published: 11 June 2024
(This article belongs to the Special Issue Advances in Medical Microbiology)

Abstract

Better diagnostic tools are needed to improve the diagnosis of Clostridioides difficile infections (CDI) and reduce the overtreatment of colonized children. In this study, we evaluated two polymerase chain reaction (PCR) assays (Cepheid GeneXpert C. difficile and the Gastroenteritis PCR Panel by QIAstat-Dx) as a standalone method in combination with the PCR cycle threshold (Ct) value in positive samples to predict the presence of free toxins. We also evaluated the clinical impact of reporting toxin production results and provided comments alongside the PCR results in our pediatric population. PCR-positive stool samples from pediatric patients (aged 2 to 18 years old) were included in our study and tested for the presence of toxins A and B using the C. difficile Quik Chek Complete kit. For the clinical intervention, the CDI treatment rates 6 months pre- and post-intervention were compared. The use of PCR Ct value showed excellent sensitivity (100%) at a Ct value cutoff of 26.1 and 27.2 using the Cepheid GeneXpert C. difficile and the Gastroenteritis PCR Panel by QIAstat-Dx, respectively, while the toxin test showed inferior sensitivity of 64% in the PCR-positive samples. In addition, CDI treatment rates were decreased by 23% post-intervention. The results of our study suggest that nucleic acid amplification test (NAAT) assays supplemented by the use of PCR Ct value for positive samples can be used as standalone tests to differentiate CDI from colonization. Furthermore, the reporting of toxin production along with the PCR results can help reduce the unnecessary treatment of colonized children.
Keywords: Clostridioides difficile; pediatric; children; cycle threshold; intervention Clostridioides difficile; pediatric; children; cycle threshold; intervention

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MDPI and ACS Style

Suleiman, M.; Tang, P.; Imam, O.; Morales, P.; Altrmanini, D.; Barr, K.L.; Roberts, J.C.; Pérez-López, A. Use of PCR Cycle Threshold and Clinical Interventions to Aid in the Management of Pediatric Clostridioides difficile Patients. Microorganisms 2024, 12, 1181. https://doi.org/10.3390/microorganisms12061181

AMA Style

Suleiman M, Tang P, Imam O, Morales P, Altrmanini D, Barr KL, Roberts JC, Pérez-López A. Use of PCR Cycle Threshold and Clinical Interventions to Aid in the Management of Pediatric Clostridioides difficile Patients. Microorganisms. 2024; 12(6):1181. https://doi.org/10.3390/microorganisms12061181

Chicago/Turabian Style

Suleiman, Mohammed, Patrick Tang, Omar Imam, Princess Morales, Diyna Altrmanini, Kelli L. Barr, Jill C. Roberts, and Andrés Pérez-López. 2024. "Use of PCR Cycle Threshold and Clinical Interventions to Aid in the Management of Pediatric Clostridioides difficile Patients" Microorganisms 12, no. 6: 1181. https://doi.org/10.3390/microorganisms12061181

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