Advertisement

A detection dog to identify patients with Clostridium difficile infection during a hospital outbreak

      Highlights

      • Early and rapid identification of Clostridium difficile infections (CDI) is important to prevent transmission.
      • A detection dog had high diagnostic accuracy (sensitivity 86%; specificity 97%) for bedside diagnosis of CDI patients.
      • For 2 CDI negative patients the dog repeatedly indicated a positive response; both did prove CDI positive weeks later.
      • More research is needed to see if the use of sniffer dogs can lead to a quicker diagnosis, and improve outbreak management.

      Summary

      Objectives

      Early and rapid identification of Clostridium difficile infections (CDI) is important to prevent transmission. In this study we assessed the diagnostic accuracy of a trained detection dog for detecting CDI cases on hospital wards in an outbreak setting.

      Methods

      During a CDI outbreak in a large Dutch university hospital, we screened affected hospital wards repeatedly with a trained detection dog. The dog's response was compared to the clinical diagnosis, supported by laboratory results.

      Results

      During a total of 9 hospital visits, the dog performed 651 screenings involving 371 participants. The dog correctly identified 12 out of 14 CDI cases [sensitivity 86% (95% confidence interval (CI): 56–97%)] and 346 out of 357 CDI negative participants [specificity of 97% (95% CI: 94–98%)]. Interestingly, of the 11 CDI negative participants that were ‘falsely’ indicated by the dog as positive, 2 (18%) did actually developed CDI during the 3 months of follow-up after the detection period; compared to only 12 of the 346 participants (3.5%) that the dog identified as C. difficile negative (p = 0.06).

      Conclusion

      A trained detection dog can accurately detect CDI in hospitalized patients during an outbreak. A (repeated) positive dog response is a strong indication of a CDI episode coming, be it the next day or possibly up to a month.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Infection
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Samore M.H.
        • Venkataraman L.
        • DeGirolami P.C.
        • Arbeit R.D.
        • Karchmer A.W.
        Clinical and molecular epidemiology of sporadic and clustered cases of nosocomial Clostridium difficile diarrhea.
        Am J Med. 1996; 100: 32-40
        • Loo V.G.
        • Poirier L.
        • Miller M.A.
        • Oughton M.
        • Libman M.D.
        • Michaud S.
        • et al.
        A predominantly clonal multi-institutional outbreak of Clostridium difficile-associated diarrhea with high morbidity and mortality.
        N Engl J Med. 2005; 353: 2442-2449
        • Freeman J.
        • Bauer M.P.
        • Baines S.D.
        • Corver J.
        • Fawley W.N.
        • Goorhuis B.
        • et al.
        The changing epidemiology of Clostridium difficile infections.
        Clin Microbiol Rev. 2010; 23: 529-549
        • Rupnik M.
        • Wilcox M.H.
        • Gerding D.N.
        Clostridium difficile infection: new developments in epidemiology and pathogenesis.
        Nat Rev Microbiol. 2009; 7: 526-536
        • Muto C.A.
        • Blank M.K.
        • Marsh J.W.
        • Vergis E.N.
        • O'Leary M.M.
        • Shutt K.A.
        • et al.
        Control of an outbreak of infection with the hypervirulent Clostridium difficile BI strain in a university hospital using a comprehensive “bundle” approach.
        Clin Infect Dis. 2007; 45: 1266-1273
        • Bomers M.K.
        • van Agtmael M.A.
        • Luik H.
        • van Veen M.C.
        • Vandenbroucke-Grauls C.M.
        • Smulders Y.M.
        Using a dog's superior olfactory sensitivity to identify Clostridium difficile in stools and patients: proof of principle study.
        BMJ. 2012; 345: e7396
        • Lefebvre S.L.
        • Golab G.C.
        • Christensen E.
        • Castrodale L.
        • Aureden K.
        • Bialachowski A.
        • et al.
        Guidelines for animal-assisted interventions in health care facilities.
        Am J Infect Control. 2008; 36: 78-85