Abstract
BackgroundMolecular diagnostic panels for enteric pathogens offer increased sensitivity and reduced turnaround time. However, many pathogen detections do not change clinical management, and the cost is substantial.MethodsWe performed a retrospective chart review of adult outpatients with diarrhea at the University of Virginia who had samples tested by the FilmArray Gastrointestinal Panel (BioFire Diagnostics, Salt Lake City, UT) to identify the clinical yield and to validate the clinical criteria for testing recommended in the 2017 Infectious Diseases Society of America (IDSA) guidelines.ResultsWe analyzed 629 tests sent from adult outpatients with diarrhea between March 23, 2015, and July 18, 2016. A pathogen was detected in 127 of 629 specimens (20.2%). The most common pathogens were enteropathogenic Escherichia coli (47, 7.5%), norovirus (24, 3.8%), enteroaggregative E. coli (14, 2.2%), Campylobacter (9, 1.4%), and Salmonella (9; 1.4%). The clinical yield of testing was low, with antimicrobial treatment clearly indicated for only 18 subjects (2.9%) and any change in clinical management indicated for 33 subjects (5.2%). Following the clinical criteria for diagnostic testing from the 2017 IDSA guidelines, which suggest diagnostic testing for patients with fever, abdominal pain, blood in stool, or an immunocompromising condition, would have reduced testing by 32.3% without significantly reducing the clinical yield (sensitivity, 97.0%; 95% confidence interval [CI], 84.2%–99.9%; negative predictive value, 99.5%; 95% CI, 97.3%–100.0%).ConclusionsThe clinical yield of molecular diagnostic testing in this population was low. Compliance with IDSA guidelines in adult outpatients with diarrhea could reduce testing by approximately one-third.
Highlights
We analyzed 629 tests sent from adult outpatients with diarrhea between March 23, 2015, and July 18, 2016
Following the clinical criteria for diagnostic testing from the 2017 Infectious Disease Society of America (IDSA) guidelines, which suggest diagnostic testing for patients with fever, abdominal pain, blood in stool, or an immunocompromising condition, would have reduced testing by 32.3% without significantly reducing the clinical yield
The evaluation and management of infectious diarrhea remain a common problem in the outpatient setting, with a broad range of etiologies accounting for 37.2 million cases per year in the United States [1]
Summary
We performed a retrospective chart review of adult outpatients with diarrhea at the University of Virginia who had samples tested by the FilmArray Gastrointestinal Panel (BioFire Diagnostics, Salt Lake City, UT) to identify the clinical yield and to validate the clinical criteria for testing recommended in the 2017 Infectious Diseases Society of America (IDSA) guidelines. We performed a retrospective chart review of adult patients who either presented to outpatient clinics or contacted outpatient clinic physicians by phone at the University of Virginia for whom a stool sample was tested by the FilmArray GI Panel (BioFire Diagnostics, Salt Lake City, UT) from March 23, 2015, to July 18, 2016. A history of HIV, inflammatory bowel disease (IBD), or transplant (including renal, liver, heart, lung, or hematopoietic stem cell) was considered present if it was documented in the chart at any time before or during the associated visit. The study was approved by the ethical review board of the University of Virginia
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