Impact of Rapid Molecular Multiplex Gastrointestinal Pathogen Testing in Management of Children during a
            <i>Shigella</i>
            Outbreak

Kanwar, Neena; Jackson, Jami; Bardsley, Tyler; Pavia, Andrew T.; Bourzac, Kevin M.; Holmberg, Kristen; Selvarangan, Rangaraj

doi:10.1128/jcm.01652-22

Cited by 6 publications

(7 citation statements)

References 13 publications

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“…(0.98%). The PCR-based method detected more gastrointestinal pathogens and coinfection than culture, consistent with published data (19)(20)(21)(22). This implies that the AllplexTM GI-Bacteria(I) assay is an important tool in the laboratory management of bacterial diarrhea.…”

Section: Discussionsupporting

confidence: 86%

Evaluating the AllplexTM GI-Bacteria (I) Assay Efficiency to Assess the Diversity of Bacterial Pathogens among Young Children with Diarrhea in Burundi

Ihorimbere,

Nzoyikorera,

Gehre

et al. 2023

Preprint

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Background Diarrheal infections are caused by many enteric pathogens that infect children as early as birth. Molecular assays are uncommon in routine diagnosis of gastrointestinal bacterial pathogens in Burundi. This study aimed to characterize the diversity of bacterial pathogens among young children with diarrhea in selected healthcare settings and to demonstrate the efficiency of the AllplexTM GI-Bacteria (I) assay over the conventional culture. Methods We conducted a cross-sectional study in seven (7) selected health districts in Burundi. We used a questionnaire to collect sociodemographic information for children ≥ 5 years old whose parents consented to participate. We collected stool samples for both conventional cultures (gold standard) and AllplexTM GI assay. We plated the stool samples shortly after collection and we kept the samples in the fridge between 4–8 ℃ for less than 24 hours before we processed them with the AllplexTM GI kit. We determined the association between sociodemographic factors and carriage of genes using a chi-square test for independence (Pearson's chi-square test or chi-square test of association). A p-value < 0.05 was considered statistically significant. Results 17.6% (18/102) of stool specimens processed with conventional methods were positive for Shigella spp. (13.7%) and Salmonella spp (3.9%). With Allplex GI, 79.4% (81/102) of stool samples were positive for different genes; sh/ei genes were detected in 40.2% (40/102) of the stool samples. An association of two genes namely sh/ei and sal or sh/ei and vib was found. AllplexTM GI-Bacteria(I) PCR Assay had a sensitivity of 94.4% and a negative predictive value (NPV) of 95.2%. There was no association between place of residence, fingernail status, level of education, and being positive for sh/ei, sal, sh/ei and sal and sh/ei and vib. Conclusion We characterized bacterial pathogens in the stool samples and we demonstrated the efficiency of the AllplexTM GI assay over conventional methods. The data could further inform the decision-makers to institute effective prevention and control measures to tackle infectious diarrhea.

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Section: Discussionsupporting

confidence: 86%

Evaluating the AllplexTM GI-Bacteria (I) Assay Efficiency to Assess the Diversity of Bacterial Pathogens among Young Children with Diarrhea in Burundi

Ihorimbere,

Nzoyikorera,

Gehre

et al. 2023

Preprint

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“…To assess the impact of a Shigella outbreak in Kansas City during the time of study, we conducted sensitivity analyses omitting Children's Mercy Hospital (CMH) observations. [15]…”

Section: Discussionmentioning

confidence: 99%

Clinical Impact of Multiplex Molecular Diagnostic Testing in Children with Acute Gastroenteritis Presenting to An Emergency Department: A Multicenter Prospective Study

Pavia

Cohen

Leber

et al. 2023

Preprint

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BackgroundMultiplex molecular diagnostic panels have greatly enhanced detection of gastrointestinal pathogens. However, data on the impact of these tests on clinical and patient-centered outcomes are limited.MethodsWe conducted a prospective, multicenter, stepped-wedge trial to determine the impact of multiplex molecular testing at five academic children’s hospitals in children presenting to the ED with acute gastroenteritis. Caregivers were interviewed on enrollment and again 7-10 days after enrollment to determine symptoms, risk factors, subsequent medical visits, and impact on family members. During the pre-intervention period, diagnostic testing was performed at the discretion of clinicians. During the intervention period, multiplex molecular testing was performed on all children with results available to clinicians. Primary outcome was return visits to a health care provider within 10 days of enrollment.ResultsPotential pathogens were identified by clinician ordered tests in 19/571 (3.3%) in the pre-intervention period compared to 434/586 (74%) in the intervention period; clinically relevant pathogens were detected in 2.1% and 15% respectively. In the multivariate model adjusting for potential confounders, the intervention was associated with a 21% reduction in the odds of any return visit (OR 0.79; 95% CI 0.70-0.90). Appropriate treatment was prescribed in 11.3% compared to 19.6% during the intervention period(P=0.22).ConclusionsRoutine molecular multiplex testing for all children presenting to the ED with AGE detected more clinically relevant pathogens and led to a 21% decrease in return visits. Additional research is needed to define patients most likely to benefit from testing.

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“…For these patient groups, broad panel testing for AGE pathogens may be most relevant. This also includes children, who are known to have an increased incidence of AGE [ 1 , 5 ]. As there is a large overlap in clinical symptoms caused by different pathogens, it is challenging to differentiate patients for more individualized testing to avoid delays in diagnostic reporting and to simplify the workflow for the emergency department staff.…”

Section: Introductionmentioning

confidence: 99%

Experience with PCR Testing for Enteric Bacteria and Viruses of Emergency Department Patients with Acute Gastroenteritis: Are There Implications for the Early Treatment of Clostridioides difficile Infection?

Iffland,

Zechel,

Lewejohann

et al. 2024

Antibiotics

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Early identification of acute gastroenteritis (AGE) pathogens via PCR may improve the management of patients presenting to the emergency department (ED). In this study, we evaluated the implementation of a testing algorithm for ED patients with AGE using the BD MAX automated PCR system. Data from 133 patients were analyzed. A total of 56 patients (42%) tested positive via PCR for at least one bacterial or viral pathogen. The median time to report PCR results was 6.17 h compared to 57.28 h for culture results for bacterial pathogens. The most common pathogen was Clostridioides difficile (n = 20, 15%). In total, 14 of the 20 C. difficile-positive patients were aged >65 years and 17 of the 20 patients (85%) were diagnosed with a clinically relevant infection based on typical symptoms and laboratory values. They received antibiotics, mostly oral vancomycin, starting a median of 11.37 h after ED admission. The introduction of PCR for the diagnosis of AGE infection in patients presenting to the ED may have the greatest impact on the rapid identification of C. difficile and the timely administration of antibiotics if necessary.

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Impact of Rapid Molecular Multiplex Gastrointestinal Pathogen Testing in Management of Children during a Shigella Outbreak

Abstract: Fecal culture for isolation and identification of Shigella may take days. The BioFire FilmArray Gastrointestinal (GI) panel (bioMérieux, France) is a PCR-based assay that detects enteric pathogens including Shigella /enteroinvasive Escherichia coli (EIEC) in about an hour.

Cited by 6 publications

References 13 publications

Evaluating the AllplexTM GI-Bacteria (I) Assay Efficiency to Assess the Diversity of Bacterial Pathogens among Young Children with Diarrhea in Burundi

Evaluating the AllplexTM GI-Bacteria (I) Assay Efficiency to Assess the Diversity of Bacterial Pathogens among Young Children with Diarrhea in Burundi

Clinical Impact of Multiplex Molecular Diagnostic Testing in Children with Acute Gastroenteritis Presenting to An Emergency Department: A Multicenter Prospective Study

Experience with PCR Testing for Enteric Bacteria and Viruses of Emergency Department Patients with Acute Gastroenteritis: Are There Implications for the Early Treatment of Clostridioides difficile Infection?

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