Abstract
BackgroundRapid and accurate diagnostic tools are needed for appropriate management of infectious diarrhea.MethodsWe evaluated the impact of the introduction of rapid multiplex PCR testing using the FilmArray gastrointestinal (GI) panel (BioFire Diagnostics, LLC, Salt Lake City, UT) at our institution, and compared the results to those of standard stool cultures.ResultsThe most common pathogens detected by the FilmArray GI panel were Clostridium difficile (55.0%), Campylobacter species (20.9%), Salmonella species (12.4%), and Shigella/EIEC species (12.4%). Rates of reproducibility in stool culture for these pathogens ranged from 56.3 to 77.8%. Co-detection of two or more organisms was common (24.2%), most commonly involving EPEC, EAEC, ETEC, and STEC. The time from arrival in the Emergency Department to discharge or admission to the hospital was unchanged after the introduction of FilmArray GI panel, but length of hospital stay was shorter (3 vs. 7.5 days, p = 0.0002) for the FilmArray group. The time to empiric antibiotics did not differ significantly, but optimal antibiotics were started earlier after introduction of the FilmArray GI panel (hospital day 1 vs. 2, p < 0.0001). More patients were discharged without antibiotics after introduction of the FilmArray GI panel (14.0% vs. 4.5%; p < 0.001).ConclusionOur results demonstrate that the FilmArray GI panel is an important tool for improving both patient care and antibiotic stewardship, despite the tendency for positive results with multiple pathogens.
Highlights
Rapid and accurate diagnostic tools are needed for appropriate management of infectious diarrhea
We evaluated the impact of adding FilmArray GI panel testing to the standard management of patients presenting to the Emergency Department (ED) with suspected infectious diarrhea over an 18-month observation period (12 months prior to the introduction of GI BioFire, and 6 months after)
The resultant groups differed in composition by gender, age, and rates of C. difficile infection (CDI) (Table 1)
Summary
Rapid and accurate diagnostic tools are needed for appropriate management of infectious diarrhea. In the United States, an estimated 179 million episodes of diarrheal illness are estimated to occur each year, resulting in nearly 500,000 hospitalizations and 5000 deaths. The economic burden of Emergency Department (ED) visits for diarrheal illnesses alone in the USA has been estimated at $580 million per year [4,5,6,7]. Stool cultures have been the standard diagnostic tool for determining the microbial etiology of suspected bacterial infectious diarrhea. Rapid and accurate diagnostic tools are needed for appropriate management of infectious gastroenteritis. Available multiplex polymerase chain reaction (PCR) testing panels may improve patient care and hospital workflow by allowing clinicians to choose the appropriate antimicrobials, or to avoid them if they are not indicated, aiding antibiotic stewardship and reduction of harm such as infection with C.lostridium difficile [12,13,14,15]
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