Rapid detection of gastrointestinal pathogens using a multiplex polymerase chain reaction gastrointestinal panel and its role in antimicrobial stewardship

J Microbiol Immunol Infect. 2023 Dec;56(6):1273-1283. doi: 10.1016/j.jmii.2023.10.004. Epub 2023 Oct 14.

Abstract

Objectives: The FilmArray gastrointestinal panel (FAGIP) is widely used to detect infectious diarrhoea due to its outstanding sensitivity compared to conventional methods, but there is geographic variation, such as in the distribution of pathogens, among populations.

Methods: This was a retrospective study that analysed patients with acute diarrhoea who underwent FAGIP tests from all age groups during 2022. We compared positive rates of FAGIP between paediatric (n = 245) and adult patients (n = 242) of different origins. The targeted therapy rate and antimicrobial agent use rate were also analysed.

Results: Among the 487 stool samples evaluated, the overall, community-origin (CO), and nosocomial (NC) positivity rates of paediatric patients were significantly higher than those of adults (73.9 % vs. 43.0 %, p = 0.000; 76.2 % vs. 51.7 %, p = 0.000; 50.0 % vs. 19.7 %, p = 0.000). Salmonella was the most frequently detected pathogen (35.9 %) in children, while the predominant pathogen in adult patients was toxin A/B-genic Clostridioides difficile (13.2 %). There was a significantly lower antimicrobial agent use rate after FAGIP results were available (79.1 % vs. 64.5 %, p = 0.000) and a higher rate of targeted therapy towards C. difficile infection in adults than in children (84.4 % vs. 69.0 %, p = 0.011).

Conclusion: Paediatric diarrhoea patients showed higher positivity rates than adult patients. Application of FAGIP for acute diarrhoea might lower unnecessary antimicrobial use.

Keywords: Acute diarrhoea; Community origin; FilmArray gastrointestinal panel; Mixed detections; Nosocomial diarrhoea; Positivity rate.

MeSH terms

  • Adult
  • Anti-Infective Agents*
  • Antimicrobial Stewardship*
  • Bacteria / genetics
  • Child
  • Clostridioides difficile*
  • Diarrhea / diagnosis
  • Diarrhea / drug therapy
  • Feces
  • Humans
  • Multiplex Polymerase Chain Reaction / methods
  • Retrospective Studies

Substances

  • Anti-Infective Agents