2177. The Impact of the BioFire® FilmArray® Gastrointestinal Syndromic Panel on the Management of Infectious Gastroenteritis due to Diarrheagenic E. coli Strains in a Large Community Hospital

Abstract

BackgroundPCR-based rapid diagnostic tests (RDTs) provide rapid and accurate infectious gastroenteritis (IGE) etiologies within hours. However, there are limited data evaluating the impact of these panels on the appropriate management for diarrheagenic E. coli strains (DECS). This study evaluated the impact of the BioFire® FilmArray® GI panel on the appropriate antimicrobial management of DECS.MethodsA retrospective analysis was conducted at a large community hospital in San Antonio, TX. Patients with a positive infectious diarrhea diagnostic panel (IDDP) for DECS from October 1, 2016 through September 30, 2018 and admitted for ≥48 hours were included. Patients were excluded if they had a positive IDDP for multiple DECS. An algorithm based on all available literature was used to classify appropriate management of DECS, which included patients having prolonged diarrhea (≥7 days), immunocompromised hosts (ICHs), or the presence of systemic symptoms. Antimicrobial therapy changes based on IDDP results, presence of an ID consult, and incidence of hemolytic uremic syndrome (HUS) were evaluated.ResultsA total of 374 patients were included for analysis. Overall, the IDDP did not lead to a change of therapy in 290 cases. However, the IDDP resulted in 84 antimicrobial changes including initiation of appropriate antibiotics (n = 48) and de-escalation/discontinuation (n = 22), primarily in special populations, such as ICHs. The IDDP results led to appropriate therapy optimization in 63%, 17%, 16%, and 9% of enteroinvasive E. coli (EIEC), enteroaggregative E. coli (EAEC), enteropathogenic E. coli (EPEC), and enterotoxigenic E. coli (ETEC) cases, respectively. In contrast, 81% of Shiga toxin-producing E. coli (STEC) cases were inappropriately managed with antibiotics, and 33% developed HUS. Only 14% of all DECS cases generated an ID consult.ConclusionOf note, this study found that the IDDP did not lead to a change in the management of most pathotypes. However, it was associated with positive changes in the management of DECS in specific patients, particularly ICHs. RDTs assist providers in the timely identification and treatment of IGE pathogens, but both antimicrobial and diagnostic stewardship remain critical for the optimal management of DECS.Disclosures All authors: No reported disclosures.