Diagnostic Stewardship for Comprehensive Gastrointestinal Pathogen Panel Tests

Abstract

Syndromic gastrointestinal (GI) panels are molecular tests that evaluate stool specimens for multiple enteric pathogens simultaneously, including viruses, bacteria, and parasites. The Luminex xTAG GI panel includes 14 microbial targets and the Biofire FilmArray GI panel includes 22. The purpose of this scoping review was to describe clinical use of these two commercially available syndromic GI panels. Compared with conventional testing, syndromic panels increase the number of potential pathogens identified by two- to fivefold. Syndromic panels were associated with non-reproducible results, positive results in the absence of clinical disease, and positive results for pathogens of unclear clinical significance. Syndromic panels were less likely to provide new information when performed > 72 h after hospital admission or when repeated within 4 weeks of a previous test. Process measures or clinical outcomes related to testing were infrequently reported. Outcomes-based research is needed to determine the clinical impact of syndromic GI panels. Strategies for diagnostic stewardship that may increase the utility of GI panels include (1) development of clinical criteria for testing, (2) use of multi-step testing algorithms that start with tests for the most common organisms (Clostridium difficile and norovirus), (3) selective reporting of results, (4) reporting results through a mediator such as the infection preventionist or antibiotic stewardship pharmacist, and (5) maintenance of separate pathways for C. difficile testing.