Use of BioFire FilmArray gastrointestinal PCR panel associated with reductions in antibiotic use, time to optimal antibiotics, and length of stay

Abstract

Background: Rapid and accurate diagnostic tools are needed for appropriate management of infectious diarrhea. Methods: We 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. Results: The 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). Conclusion: Our 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.

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

“…The main advantage of the BioFire ® GI Panel was that it was able to replace the five to six conventional stool testing methods available at the hospital, meanwhile maintaining high detection positivity rates for the 22 pathogens included in the panel. Like previous reports, the BioFire ® GI Panel showed a higher pathogen positivity rate than conventional stool tests in this study [ 17 , 25 ]. In fact, when BioFire ® GI Panel was compared to both conventional testing methods in the prospective and historical cohort, the detection positivity rates were significantly higher for both.…”

“…With the introduction of the BioFire ® GI Panel, there have been controversies on the actual benefit and impact that the test may have in treating patients with AGE. However, studies related to the clinical utility of these tests have been lacking and real-world data on children with AGE are important and urgent [ 17 , 24 ]. To our knowledge, this study is the first prospective study on the clinical utility of BioFire ® GI Panel in pediatric AGE patients.…”

“…Currently, there is still insufficient research on whether multiplex-PCR-based GI pathogen panel examination can lead to quantifiable improvements in patient care, and no studies have been conducted specifically on children [ 17 , 18 , 19 , 20 ]. Therefore, the primary endpoint of this study was to investigate whether using the BioFire ® FilmArray ® Gastrointestinal Panel (GI Panel) in children with acute diarrhea brought on quality improvement in patient management, antibiotic stewardship, and in-hospital infection transmission prevention.…”

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

“…These tests have recently been shown to reduce time to appropriate antibiotic therapy and reduce length of stay when compared with conventional methods. 16 They also provide a cost benefit via reducing additional diagnostic stool tests and imaging studies. 5 Generally, the results of the GI panel in this study produced an observable difference in antibiotic therapy as those with negative panel results had reduced exposure to antibiotics.…”

The effect of gastrointestinal pathogen panel (GIP) on antibiotic management

“…Recent studies demonstrated its utility within the hospital setting. Torres-Miranda et al 1 found that GIP testing led to decreased median hospital length of stay (LOS) by 4 days in patients with diarrhea. Furthermore, the mean time to appropriate antibiotic therapy was shortened by 24 hours in those who underwent GIP testing.…”