{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T09:08:34Z","timestamp":1740128914193,"version":"3.37.3"},"reference-count":29,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2023,1,31]],"date-time":"2023-01-31T00:00:00Z","timestamp":1675123200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"name":"AMR One Health Consortium University of Calgary"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,6,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Management of suspected Clostridioides difficile infection (CDI) in the hospital setting typically results in patient isolation, laboratory testing, infection control, and presumptive treatment. We investigated whether implementation of rapid near-patient testing (NPT) reduced patient isolation time, hospital length of stay (LOS), antibiotic usage, and cost.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A 2-period pragmatic cluster randomized crossover trial was conducted. Thirty-nine wards were randomized into 2 study arms. The primary outcome measure was effect of NPT on patient isolation time using a mixed-effects generalized linear regression model. Secondary outcomes examined were hospital LOS and antibiotic therapy based on a negative binomial regression model. Natural experiment (NE), intention-to-treat (ITT), and per-protocol (PP) analyses were conducted.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>During the entire study period, a total of 656 patients received NPT for CDI and 1667 received standard-of-care testing. For the primary outcome, a significant decrease of patient isolation time with NPT was observed (NE, 9.4 hours [P &amp;lt; .01]; ITT, 2.3 hours [P &amp;lt; .05]; PP, 6.7 hours [P &amp;lt; .1]). A significant reduction in hospital LOS was observed with NPT for short stay (NE, 47.4% [P &amp;lt; .01]; ITT, 18.4% [P &amp;lt; .01]; PP, 34.2% [P &amp;lt; .01]). Each additional hour delay for a negative result increased metronidazole use (24 defined daily doses per 1000 patients; P &amp;lt; .05) and non-CDI-treating antibiotics by 70.13 mg (P &amp;lt; .01). NPT was found to save 25.48 US dollars per patient when including test cost to the laboratory and patient isolation in the hospital.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>This pragmatic cluster randomized crossover trial demonstrated that implementation of CDI NPT can contribute to significant reductions in isolation time, hospital LOS, antibiotic usage, and healthcare cost.<\/jats:p>\n                  <jats:p>Clinical Trials Registration. NCT03857464.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciad046","type":"journal-article","created":{"date-parts":[[2023,1,31]],"date-time":"2023-01-31T18:18:09Z","timestamp":1675189089000},"page":"1911-1918","source":"Crossref","is-referenced-by-count":1,"title":["<i>Clostridioides difficile<\/i> Near-Patient Testing Versus Centralized Testing: A Pragmatic Cluster Randomized Crossover Trial"],"prefix":"10.1093","volume":"76","author":[{"given":"Cody P","family":"Doolan","sequence":"first","affiliation":[{"name":"Department of Microbiology, Immunology, and Infectious Diseases, University of Calgary , Alberta , Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Babak","family":"Sahragard","sequence":"additional","affiliation":[{"name":"Department of Economics, Simon Fraser University , Burnaby, British Columbia , Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jenine","family":"Leal","sequence":"additional","affiliation":[{"name":"Infection Prevention and Control, Alberta Health Services , Calgary, Alberta , Canada"},{"name":"Department of Community Health Sciences, University of Calgary , Alberta , Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anuj","family":"Sharma","sequence":"additional","affiliation":[{"name":"Ephicacy Canada Inc. , Toronto, Ontario , Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph","family":"Kim","sequence":"additional","affiliation":[{"name":"Infection Prevention and Control, Alberta Health Services , Calgary, Alberta , Canada"},{"name":"Department of Medicine, University of Calgary , Calgary, Alberta , Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eldon","family":"Spackman","sequence":"additional","affiliation":[{"name":"Department of Community Health Sciences, University of Calgary , Alberta , Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aidan","family":"Hollis","sequence":"additional","affiliation":[{"name":"Department of Economics, University of Calgary , Calgary, Alberta , Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dylan R","family":"Pillai","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Calgary , Calgary, Alberta , Canada"},{"name":"Alberta Precision Laboratories , Calgary, Alberta , Canada"},{"name":"Department Pathology and Laboratory Medicine, University of Calgary , Alberta , Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2023,1,31]]},"reference":[{"key":"2023060818535641600_ciad046-B1","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1111\/1469-0691.12221","article-title":"Does a rapid diagnosis of Clostridium difficile infection impact on quality of patient 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