Pediatric Enteric Diagnostic Stewardship: The Right Test in the Right Context.

Abstract

In this issue of Pediatrics , Cotter et al1 offer valuable analysis of the utility of molecular (nucleic acid amplification) enteric pathogen diagnostic technology in hospitalized children. These tests return highly worthwhile information for some infections, but many of their results are prone to misinterpretation. However, diagnostic guidelines based on classic microbiologic techniques do not perform well either.2 Molecular enteric microbiology is, therefore, a model opportunity for diagnostic stewardship to maximize worth and minimize wasteful expense. Cotter et al1 find that only 3.7% of tested hospitalized children benefitted from molecular diagnosis in terms of decreased length of stay and/or initiation of appropriate treatment. These data reinforce previous findings: enteric diagnostic use increases briskly after molecular testing becomes available and the tests find many unexpected signals reflecting difficult-to-interpret and/or nonactionable microbes. The authors candidly acknowledge the study’s limitations: nongeneralizability (their findings do not apply to outpatients) and reliance on historic comparison data. The benefit they cite applies to hospitalized children, and such populations are probably enriched for severe bacterial infections for which rapid and accurate molecular diagnosis has the greatest value; one would expect different yields in emergency facilities and ambulatory settings. … Address correspondence to Gillian A. M. Tarr, PhD, School of Public Health, University of Minnesota, MMC 807, 420 Delaware St SE, Minneapolis, MN 55455. E-mail: gtarr{at}umn.edu