Quality Improvements in Management of Children with Acute Diarrhea Using a Multiplex-PCR-Based Gastrointestinal Pathogen Panel.

In Hyuk Yoo,Hanwool Cho,In Young Yoo,Sung Jin Jo,Yeon Joon Park,Dae Chul Jeong,Hyun Mi Kang,Woosuk Suh

doi:10.3390/diagnostics11071175

In Hyuk Yoo, Hanwool Cho + Show 6 more

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https://doi.org/10.3390/diagnostics11071175

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Journal: Diagnostics	Publication Date: Jun 28, 2021
Citations: 8	License type: CC BY 4.0

Affiliation: Catholic University of Korea, Eulji University

Abstract

Conventional methods for etiologic diagnoses of acute gastroenteritis (AGE) are time consuming and have low positive yield leading to limited clinical value. This study aimed to investigate quality improvements in patient management, antibiotic stewardship, and in-hospital infection transmission prevention using BioFire® FilmArray® Gastrointestinal Panel (GI Panel) in children with acute diarrhea. This was a prospective study recruiting children < 19 years old with new onset diarrhea during the study period, and a matched historical cohort study of children diagnosed with AGE during the 4 years prior. Patients in the prospective cohort underwent stool testing with GI Panel and conventional methods. A total of 182 patients were included in the prospective cohort, of which 85.7% (n = 156) had community-onset and 14.3% (n = 26) had hospital-onset diarrhea. A higher pathogen positivity rate for community-onset diarrhea was observed by the GI Panel (58.3%, n = 91) compared to conventional studies (42.3%, n = 66) (p = 0.005) and historical cohort (31.4%, n = 49) (p < 0.001). The stool tests reporting time after admission was 25 (interquartile range, IQR 17–46) hours for the GI Panel, and 72 (IQR 48–96) hours for the historical cohort (p < 0.001). A significant reduction in antibiotic use was observed in the prospective cohort compared to historical cohort, 35.3% vs. 71.8%; p < 0.001), respectively. Compared to the GI Panel, norovirus ICT was only able to detect 4/11 (36.4%) patients with hospital-onset and 14/27 (51.8%) patients with community-onset diarrhea. The high positivity rate and rapid reporting time of the GI Panel had clinical benefits for children admitted for acute diarrhea, especially by reducing antibiotic use and enabling early adequate infection precaution and isolation.

Highlights

IntroductionAcute gastroenteritis (AGE) remains a common cause of morbidity and mortality in infants and children worldwide [1,2,3]
The first part of the study was a prospective study recruiting children below 19 years old that fit one of the two following criteria: (1) visited the emergency department or were admitted with symptoms of acute diarrhea with diarrhea onset within 72 h, or (2) patients that had no diarrhea at admission, and a new onset of diarrhea at least 72 h after admission for the purpose of treating another disease
214 papatients with acute diarrhea suspected an infectious etiology tients with acute diarrhea suspected of an infectious etiology were recruited

Summary

Introduction

Acute gastroenteritis (AGE) remains a common cause of morbidity and mortality in infants and children worldwide [1,2,3]. Global mortality from diarrheal diseases have declined significantly over the past two decades, diarrhea is still the fifth leading cause of death in children under 5 years of age, and AGE is one of the common causes of mortality in children in low-income countries [2]. AGE is a major causes of emergency room visits or hospitalizations in children, and the resulting health care and economic burden of AGE remains high [4,5]. AGE is usually caused by infections with viral, bacterial, or parasitic pathogens [6]

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