Diagnostic Stewardship for Comprehensive Gastrointestinal Pathogen Panel Tests

Baghdadi, Jonathan; Coffey, Kelly; Leekha, Surbhi; Johnson, J. Kristie; Diekema, Daniel J.; Morgan, Daniel J.

doi:10.1007/s11908-020-00725-y

Cited by 10 publications

(7 citation statements)

References 84 publications

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“…Baghdadi and colleagues showed diminished utility and lack of novel diagnoses when a multiplex GI panel was run after more than 72 h of hospitalization. 15 Panels conducted well into hospital admission are not useful, and increase the risk of incidental or collateral findings. Concerns with hospital-acquired CDI should prompt testing with a C. difficile -specific test.…”

Section: Discussionmentioning

confidence: 99%

Evaluating appropriateness and diagnostic stewardship opportunities of multiplex polymerase chain reaction gastrointestinal testing within a hospital system

O’Neal

Murray

Dash

et al. 2020

Therapeutic Advances in Infection

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Objective: This single-center, retrospective, observational cohort study evaluates the appropriateness of the BioFire® FilmArray® Gastrointestinal (GI) multiplex PCR panel testing at a community-teaching hospital. Methods: All adult, hospitalized patients at Prisma Health Richland Hospital with a documented GI multiplex PCR panel from 1 April 2015 through 28 February 2018 were included in the analysis. Inappropriate use of the GI panel was defined as a test obtained without documented diarrhea, greater than 2 days of hospitalization, redundant use with other diagnostic tests (e.g. Clostridioides difficile PCR), or laxative use in the preceding 48 h. Antibiotic use and host variables were compared between groups with positive and negative results. Results: During the study period, 442 GI panels were obtained, among which 268 (61%) were deemed inappropriate. Primary reasons for inappropriate testing were lack of documented diarrhea ( n = 92), greater than 2 days of hospitalization ( n = 116), having a duplicate C. difficile PCR test ordered ( n = 118), or laxative use in the 48 h before testing ( n = 36). A total of 141 (32%) GI panels were positive. The most frequently identified pathogens were C. difficile (51.1%, n = 72), Enteropathogenic Escherichia coli (17.7%, n = 25), and Norovirus GI/GII (12.1%, n = 17). Patients with negative GI panel results were initiated on antibiotics significantly less frequently than those with positive GI panels (62.5% versus 80.2%, p < 0.00001). Conclusion: Stewardship opportunities exist to optimize the diagnostic application of the GI multiplex PCR panel.

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Section: Discussionmentioning

confidence: 99%

Evaluating appropriateness and diagnostic stewardship opportunities of multiplex polymerase chain reaction gastrointestinal testing within a hospital system

O’Neal

Murray

Dash

et al. 2020

Therapeutic Advances in Infection

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“…For example, molecular testing for C. difficile is included in several comprehensive stool testing panels; therefore, if performed in addition to other CDI testing, these could be unnecessarily duplicative and could yield conflicting results. 136 Low-yield scenarios for implementation of syndromic panels should be considered and, if multiplex panels are adopted for higher-yield use cases, these diagnostic tests should be carefully stewarded. 7 Furthermore, implementation of highly sensitive non-culture-based diagnostic tests might identify organisms that did not appear in cultures and do not definitively indicate the organism is responsible for the symptoms the patient is experiencing nor do they distinguish colonization from infection.…”

Section: Discussionmentioning

confidence: 99%

Leveraging diagnostic stewardship within antimicrobial stewardship programmes

Claeys¹,

Johnson²

2023

DIC

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Novel diagnostic stewardship in infectious disease consists of interventions that modify ordering, processing, and reporting of diagnostic tests to provide the right test for the right patient, prompting the right action. The interventions work upstream and synergistically with traditional antimicrobial stewardship efforts. As diagnostic stewardship continues to gain public attention, it is critical that antimicrobial stewardship programmes not only learn how to effectively leverage diagnostic testing to improve antimicrobial use but also ensure that they are stakeholders and leaders in developing new diagnostic stewardship interventions within their institutions. This review will discuss the need for diagnostic and antimicrobial stewardship, the interplay of diagnostic and antimicrobial stewardship, evidence of benefit to antimicrobial stewardship programmes, and considerations for successfully engaging in diagnostic stewardship interventions. This article is part of the Antibiotic stewardship Special Issue: https://www.drugsincontext.com/special_issues/antimicrobial-stewardship-a-focus-on-the-need-for-moderation

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“…Another method of CDI diagnostic stewardship includes suppression of C. difficile test results from multiplex molecular panels for gastrointestinal pathogens. Multiplex gastrointestinal panels are subject to the same low analytic specificity as other C. difficile NAATs but are often ordered for patients with different epidemiologic pretest probabilities, which is why multiple studies have shown that these panels are less specific than standalone PCR testing for CDI [20].…”

Section: Diagnostic Stewardship Interventions By Syndromementioning

confidence: 99%

“…Gastrointestinal panels are a prime target for diagnostic stewardship, as they often include pathogens of unclear clinical significance while increasing the number of identified organisms by two to five-fold [20]. With increased target identification, gastrointestinal syndromic panels may be associated with an overall increase in antibiotics prescribed, leading to associated adverse events and selective antimicrobial resistance, though quantifying data are limited.…”

Section: Diagnostic Stewardship Interventions By Syndromementioning

confidence: 99%

Diagnostic stewardship: what impacts antibiotics use?

Coffey

Morgan

Claeys

2023

Current Opinion in Infectious Diseases

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Purpose of review The aim of this study was to review recently published diagnostic stewardship studies of common clinical infectious syndromes and the impact on antibiotic prescribing. Recent findings Diagnostic stewardship can be implemented within healthcare systems and tailored to infectious syndromes, including urinary tract, gastrointestinal, respiratory and bloodstream infections. In urinary syndromes, diagnostic stewardship can decrease unnecessary urine culturing and associated antibiotic prescribing. Diagnostic stewardship of Clostridium difficile testing can decrease antibiotics and test ordering with a reduction in healthcare-associated C. difficile infections. Respiratory syndrome multiplex arrays can decrease time to results and increase detection of clinically relevant pathogens but may not decrease antibiotics use, or worse, could increase over-prescribing if diagnostic stewardship of ordering practices is not exercised. Lastly, blood culturing practices can be improved by clinical decision support to safely decrease collection and broad-spectrum antibiotic use. Summary Diagnostic stewardship decreases unnecessary antibiotic use in a way that is different from and complementary to antibiotic stewardship. Further studies are needed to quantify the full impact on antibiotic use and resistance. Future considerations should be to institutionalize diagnostic stewardship in patient care activities to leverage integration into systems-based interventions.

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Diagnostic Stewardship for Comprehensive Gastrointestinal Pathogen Panel Tests

Cited by 10 publications

References 84 publications

Evaluating appropriateness and diagnostic stewardship opportunities of multiplex polymerase chain reaction gastrointestinal testing within a hospital system

Evaluating appropriateness and diagnostic stewardship opportunities of multiplex polymerase chain reaction gastrointestinal testing within a hospital system

Leveraging diagnostic stewardship within antimicrobial stewardship programmes

Diagnostic stewardship: what impacts antibiotics use?

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