Rapid molecular syndromic testing for aetiological diagnosis of gastrointestinal infections and targeted antimicrobial prescription: experience from a reference paediatric hospital in Spain

Marta Castany-Feixas,Mariona Fernandez De Sevilla,Amadeu Gene,Selene Garcia-Garcia,Cristian Launes,Marlene Kalkgruber,Carmen Muñoz-Almagro,Silvia Simo,Pedro Brotons

doi:10.1007/s10096-021-04266-7

Abstract

Aetiological diagnosis of gastrointestinal infections is challenging since a wide range of bacteria, parasites and viruses can be causal agents and derived clinical manifestations appear quite similar. Our aim was to evaluate contribution of the novel QIAstat-DxGastrointestinal Panel (GIP) to aetiological diagnosis of gastrointestinal infections and rational antimicrobial prescription in a reference paediatric hospital. Evaluation included comparison of diagnostic yield and agreement of results of QIAstat-Dx GIP and conventional microbiological methods. Parallel testing was performed on stool samples collected prospectively from children admitted to Sant Joan de Deu Barcelona Hospital (Spain) during the period February–March 2019. Influence of the panel test use on antimicrobial prescription was assessed using a pre–post study design. Eighty-six (68.8%) out of 125 specimens were positive by QIAstat-Dx GIP versus 44 (35.2%) positive by a composite of conventional methods (p<0.001). Global agreement of panel test results with rotavirus-adenovirus antigen detection (92.8%) and a two-step antigen/toxin and PCR-based algorithm for toxigenic Clostridioides difficile detection (87.5%) was greater than that with bacterial culture (76.0%) and parasite microscopic identification (64.3%). Panel test results orientated antimicrobial prescription changes in 18 (14.4%) patients, including antimicrobial start in 11 cases initially untreated, targeted antimicrobial prescription in 5 and discontinuation in 2 cases empirically treated. Results showed that QIAstat-Dx GIP significantly expanded aetiological diagnosis of gastrointestinal infections compared to conventional microbiological methods while orientating a more judicious use of antimicrobial drugs in hospitalised children.

Highlights

Marta Castany-Feixas and Silvia Simo contributed to this work.Madrid, Spain 3 Universitat Internacional de Catalunya, Barcelona, Spain 4 University Hospital Sant Joan de Deu, P° Sant Joan de Déu, n° 208950 Esplugues, Barcelona, Spain 5 Universitat de Barcelona, Barcelona, SpainDiarrhoea remains an important global health problem that was estimated to cause 1.6 million deaths in 2016 [1]
Aetiological diagnosis of gastrointestinal infections has relied on diverse microbiological methods such as stool bacterial culture, parasite microscopic examination, antigen-based detection of specific viruses and nucleic acid
Inclusion criteria were as follows: (1) use of fresh loose stool samples collected from patients ≤18 years of age hospitalised in the study site with suspicion of gastrointestinal infection and diarrhoea symptomatology; (2) stool testing by QIAstat-Dx GIP, bacterial culture and rotavirus-adenovirus antigen detection, as well as microscopic examination for identification of parasites and performance of a 2-step antigen/ toxin and PCR-based algorithm for toxigenic C. difficile detection in specific patients; and (3) selection of the first stool sample produced by each patient

Summary

Introduction

Marta Castany-Feixas and Silvia Simo contributed to this work.Madrid, Spain 3 Universitat Internacional de Catalunya, Barcelona, Spain 4 University Hospital Sant Joan de Deu, P° Sant Joan de Déu, n° 208950 Esplugues, Barcelona, Spain 5 Universitat de Barcelona, Barcelona, SpainDiarrhoea remains an important global health problem that was estimated to cause 1.6 million deaths in 2016 [1]. Spain 3 Universitat Internacional de Catalunya, Barcelona, Spain 4 University Hospital Sant Joan de Deu, P° Sant Joan de Déu, n° 2. 08950 Esplugues, Barcelona, Spain 5 Universitat de Barcelona, Barcelona, Spain. Diarrhoea remains an important global health problem that was estimated to cause 1.6 million deaths in 2016 [1]. Diarrhoea usually occurs in the context of an acute or chronic gastrointestinal infection. Aetiological diagnosis of gastrointestinal infections is challenging since a wide range of bacteria, parasites and viruses can be causal agents [6, 7], and derived clinical manifestations appear quite similar [8]. Aetiological diagnosis of gastrointestinal infections has relied on diverse microbiological methods such as stool bacterial culture, parasite microscopic examination, antigen-based detection of specific viruses and nucleic acid

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Conclusion