Conventional methods for the identification of gastrointestinal pathogens are time-consuming and expensive and have limited sensitivity. The aim of this study was to determine the clinical impact of a comprehensive molecular test, the BioFire FilmArray gastrointestinal (GI) panel, which tests for many of the most common agents of infectious diarrhea in approximately 1 h. Patients with stool cultures submitted were tested on the GI panel ( = 241) and were compared with control patients ( = 594) from the year prior. The most common organisms detected by the GI panel were enteropathogenic (EPEC, = 21), norovirus ( = 21), rotavirus ( = 15), sapovirus ( = 9), and ( = 8). Patients tested on the GI panel had an average of 0.58 other infectious stool tests compared with 3.02 in the control group ( = 0.0001). The numbers of days on antibiotic(s) per patient were 1.73 in the cases and 2.12 in the controls ( = 0.06). Patients with the GI panel had 0.18 abdomen and/or pelvic imaging studies per patient compared with 0.39 ( = 0.0002) in the controls. The average length of time from stool culture collection to discharge was 3.4 days in the GI panel group versus 3.9 days in the controls ( = 0.04). The overall health care cost could have decreased by $293.61 per patient tested. The GI panel improved patient care by rapidly identifying a broad range of pathogens which may not have otherwise been detected, reducing the need for other diagnostic tests, reducing unnecessary use of antibiotics, and leading to a reduction in hospital length of stay.

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Tattoo popularity continues to rise, with 3 in 10 Americans bearing at least one. Among tattoo complications, non-tuberculous mycobacteria (NTM) has emerged as a global public health concern. NTM infections associated with tattooing of immunocompetent individuals have occurred as sporadic cases and community outbreaks. Water sources are considered the major pathogenic reservoirs. Tattoo-related inoculation has been linked to contamination of ink, either during the manufacturing process or during dilution of black ink using non-sterile water. NTM infections have also been documented in a number of cosmetic and surgical procedures, including cutaneous surgery, Mohs micrographic surgery, mesotherapy, liposuction and laser resurfacing. NTM inoculation through exposure to contaminated water or non-sterile instruments remains a challenge for dermatologists and risk to patients. We reported a case of cutaneous infection following tattoo placement. This report underscores the importance of clinicians to consider NTM infections in the differential diagnosis of procedure-related reactions.

KEYWORDS 3-day rule, GI panel, stool testing T he "3-day rule" is a commonly used policy in microbiology laboratories, as literature suggests that stool tests performed after a patient has been in the hospital for 3 days are unlikely to recover any pathogens (1-3). Nikolic and colleagues (4) recently reported the implementation of a clinical decision support tool which prohibits electronic ordering of stool culture, the Giardia/Cryptosporidium enzyme immunoassay (EIA), and ovum and parasite examinations for patients who have been in the hospital for more than 3 days. The restriction can be overridden by calling the laboratory. The authors reported that the number of tests that were performed on patients who were in the hospital for greater than 3 days following the implementation fell approximately in half. Throughout the study period (22 months), they found one patient each with Endolimax nana, Cryptosporidium, Campylobacter, Salmonella, and Strongyloides in the population hospitalized for Ͼ3 days.Gastrointestinal molecular (PCR) panels are becoming more commonly used and have replaced conventional testing methods in many labs. Validation of the 3-day rule in settings where a gastrointestinal (GI) panel is used has not been published. We recently reported our results of a clinical evaluation of the FilmArray GI panel, in which we performed the GI panel on samples with an order for a stool culture (5). Of 241 patients in our study, 41 samples were submitted from patients who had been admitted for Ͼ72 h. Six of these samples were found to be positive. The patients' characteristics and the organisms that were identified are shown in Table 1. The percent positivity rates for samples collected before and after 72 h were 36.5% and 14.6%. We did not report Clostridium difficile results from the panel.Although the 3-day rule appears to lead to cost savings when used for conventional methods, such as the EIA, microscopic examinations, and cultures, it may not apply to the use of a GI PCR panel with a far higher probability of detecting potential pathogens.Certain organisms may lead to symptoms or worsening of symptoms during a hospitalization, such as Giardia or Cryptosporidium, especially if the patient is undergoing an immunosuppressing therapy (i.e., chemotherapy). A recent study of the FilmArray GI panel on immunocompromised hematologic patients found that of 61 patients who submitted stool samples Ͼ72 h after admission, 3 were positive for Norovirus, 2 were positive for Campylobacter, and one each was positive for Giardia, enteropathogenic Escherichia coli (EPEC), and enterotoxigenic E. coli (6). In this patient population, long hospital stays are common.