Quality Improvements in Management of Children with Acute Diarrhea Using a Multiplex-PCR-Based Gastrointestinal Pathogen Panel

Abstract

Conventional methods for etiologic diagnoses of acute gastroenteritis (AGE) are time consuming and have low positive yield leading to limited clinical value. This study aimed to investigate quality improvements in patient management, antibiotic stewardship, and in-hospital infection transmission prevention using BioFire® FilmArray® Gastrointestinal Panel (GI Panel) in children with acute diarrhea. This was a prospective study recruiting children <19 years old with new onset diarrhea during the study period, and a matched historical cohort study of children diagnosed with AGE during the 4 years prior. Patients in the prospective cohort underwent stool testing with GI Panel and conventional methods. A total of 182 patients were included in the prospective cohort, of which 85.7% (n = 156) had community-onset and 14.3% (n = 26) had hospital-onset diarrhea. A higher pathogen positivity rate for community-onset diarrhea was observed by the GI Panel (58.3%, n = 91) compared to conventional studies (42.3%, n = 66) (p = 0.005) and historical cohort (31.4%, n = 49) (p < 0.001). The stool tests reporting time after admission was 25 (interquartile range, IQR 17–46) hours for the GI Panel, and 72 (IQR 48–96) hours for the historical cohort (p < 0.001). A significant reduction in antibiotic use was observed in the prospective cohort compared to historical cohort, 35.3% vs. 71.8%; p < 0.001), respectively. Compared to the GI Panel, norovirus ICT was only able to detect 4/11 (36.4%) patients with hospital-onset and 14/27 (51.8%) patients with community-onset diarrhea. The high positivity rate and rapid reporting time of the GI Panel had clinical benefits for children admitted for acute diarrhea, especially by reducing antibiotic use and enabling early adequate infection precaution and isolation.

The Impact of a Positive Biofire® FilmArray® Gastrointestinal Panel Result on Clinical Management and Outcomes

“…No Shigella was detected by stool culture, and only one case (1.6%) was detected by GIP. These results reinforce previous reports, according to which the GIP has a higher positivity rate compared to culture [ 19 , 23 , 24 , 25 , 26 ]. This can be attributed to the main limits of culture, including the difficulties in culturing bacteria when the sample was collected after antibiotic administration or when the causative bacterium is fastidious and has special growth requirements.…”

High Burden of Co-Infection with Multiple Enteric Pathogens in Children Suffering with Diarrhoea from Rural and Peri-Urban Communities in South Africa

“…The laboratories at referral hospitals in rural and peri-urban areas are not always able to perform standard tests on a regular basis [ 17 ]. Recent advances of molecular diagnostics tests that use multiplex assays able to target several different pathogens (bacteria, viruses and parasites) within a single reaction have made it possible to characterize the clinical aetiology and epidemiology of infectious diarrhoea [ 18 , 19 , 20 , 21 , 22 ]. In this study, the BioFire Filmarray Gastrointestinal (GI) panel, which detects 22 diarrhoeal pathogens, was used to determine the prevalence of single and multiple viral, bacterial and parasitic pathogens causing diarrhoea in children younger than five years of age from rural and peri-urban communities in South Africa to understand the aetiology of diarrhoea.…”

Comparison of a Rapid Multiplex Gastrointestinal Panel with Standard Laboratory Testing in the Management of Children with Hematochezia in a Pediatric Emergency Department: Randomized Controlled Trial

“…The BioFire FilmArray gastrointestinal panel (bioMérieux Canada Inc., Quebec, Canada) is a multiplexed nucleic acid (NA) amplification assay that simultaneously identifies 22 enteric pathogens, including targets for E. coli O157:H7 and the Shiga toxin ( stx 1 and stx 2 ) genes ( 8 ). It provides results with a 1-h run time and has excellent diagnostic sensitivity and specificity ( 9 ), and its usage has been demonstrated to reduce antibiotic use among hospitalized children with acute diarrhea ( 10 ). As such, it has the potential to rapidly identify STEC-infected children at risk for HUS while simultaneously ruling out such infections in the majority of children, thereby reducing the need for close monitoring while awaiting culture results ( 11 ).…”