Point-Counterpoint: What Is the Optimal Approach for Detection of Clostridium difficile Infection?
Point-Counterpoint: What Is the Optimal Approach for Detection of Clostridium difficile Infection?
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DOI：
10.1128/jcm.02463-16
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发表时间：
2017-03-01
影响因子：
9.4
通讯作者：
Wilcox, Mark H.
中科院分区：
文献类型：
--
作者：
Fang, Ferric C.;Polage, Christopher R.;Wilcox, Mark H.
引言2010年，我们发表了艰难梭菌感染（CDI）实验室诊断的初步点-对应点。当时，核酸扩增测试（NAAT）刚刚商业化，CDI的算法方法的想法正在探索中。现在，市场上有许多NAAT，根据最近的能力测试调查，它们已成为美国用于CDI诊断的主要方法。与此同时，有大量文献表明NAAT缺乏临床特异性，从而提高了CDI率。医院管理人员正在注意机构CDI率，因为它们是公开报告的。它们已成为影响医院安全评级和基于价值的采购的重要指标;医院可能有数百万美元的报销风险。在这个使用常见问题方法的点-对应点中，华盛顿大学的Ferric Fang一直是CDI诊断的仅NAAT方法的一贯倡导者，他将讨论仅NAAT方法的价值，而加州大学的Christopher Polage和英国利兹利兹大学的Mark Wilcox，他们中的每一个人最近都写了关于毒素检测在诊断中的价值的重要文章，将讨论毒素检测在CDI诊断中的影响。
INTRODUCTIONIn 2010, we published an initial Point-Counterpoint on the laboratory diagnosis of Clostridium difficile infection (CDI). At that time, nucleic acid amplification tests (NAATs) were just becoming commercially available, and the idea of algorithmic approaches to CDI was being explored. Now, there are numerous NAATs in the marketplace, and based on recent proficiency test surveys, they have become the predominant method used for CDI diagnosis in the United States. At the same time, there is a body of literature that suggests that NAATs lack clinical specificity and thus inflate CDI rates. Hospital administrators are taking note of institutional CDI rates because they are publicly reported. They have become an important metric impacting hospital safety ratings and value-based purchasing; hospitals may have millions of dollars of reimbursement at risk. In this Point-Counterpoint using a frequently asked question approach, Ferric Fang of the University of Washington, who has been a consistent advocate for a NAAT-only approach for CDI diagnosis, will discuss the value of a NAAT-only approach, while Christopher Polage of the University of California Davis and Mark Wilcox of Leeds University, Leeds, United Kingdom, each of whom has recently written important articles on the value of toxin detection in the diagnosis, will discuss the impact of toxin detection in CDI diagnosis.