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Ray LC, Payne DC, Rounds J, Trevejo RT, Wilson E, Burzlaff K, Garman KN, Lathrop S, Rissman T, Wymore K, Wozny S, Wilson S, Francois Watkins LK, Bruce BB, Weller DL. Syndromic Gastrointestinal Panel Diagnostic Tests Have Changed our Understanding of the Epidemiology of Yersiniosis-Foodborne Diseases Active Surveillance Network, 2010-2021. Open Forum Infect Dis 2024; 11:ofae199. [PMID: 38868306 PMCID: PMC11167669 DOI: 10.1093/ofid/ofae199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 04/05/2024] [Indexed: 06/14/2024] Open
Abstract
Background In the US, yersinosis was understood to predominantly occur in winter and among Black or African American infants and Asian children. Increased use of culture-independent diagnostic tests (CIDTs) has led to marked increases in yersinosis diagnoses. Methods We describe differences in the epidemiology of yersiniosis diagnosed by CIDT versus culture in 10 US sites, and identify determinants of health associated with diagnostic method. Results Annual reported incidence increased from 0.3/100 000 in 2010 to 1.3/100 000 in 2021, particularly among adults ≥18 years, regardless of race and ethnicity, and during summer months. The proportion of CIDT-diagnosed infections increased from 3% in 2012 to 89% in 2021. An ill person's demographic characteristics and location of residence had a significant impact on their odds of being diagnosed by CIDT. Conclusions Improved detection due to increased CIDT use has altered our understanding of yersinosis epidemiology, however differential access to CIDTs may still affect our understanding of yersinosis.
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Affiliation(s)
- Logan C Ray
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Daniel C Payne
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Joshua Rounds
- Minnesota Department of Health, St. Paul, Minnesota, USA
| | | | - Elisha Wilson
- Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | - Kari Burzlaff
- New York State Department of Health, Albany, New York, USA
| | - Katie N Garman
- Tennessee Department of Health, Nashville, Tennessee, USA
| | - Sarah Lathrop
- New Mexico Emerging Infections Program, Albuquerque, New Mexico, USA
| | - Tamara Rissman
- Connecticut Emerging Infections Program, Hartford, Connecticut, USA
| | - Katie Wymore
- California Department of Public Health, Oakland, California, USA
| | - Sophia Wozny
- Maryland Department of Health, Baltimore, Maryland, USA
| | - Siri Wilson
- Georgia Department of Public Health, Atlanta, Georgia, USA
| | - Louise K Francois Watkins
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Beau B Bruce
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Daniel L Weller
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Hitchcock MM, Gomez CA, Pozdol J, Banaei N. Effective Approaches to Diagnostic Stewardship of Syndromic Molecular Panels. J Appl Lab Med 2024; 9:104-115. [PMID: 38167764 DOI: 10.1093/jalm/jfad063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 08/08/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Syndromic molecular panels for the diagnosis of gastroenteritis, meningitis/encephalitis, and pneumonia are becoming routinely used for patient care throughout the world. CONTENT These rapid, sample-to-answer assays have great potential to improve patient care, infection control, and antimicrobial stewardship. However, diagnostic stewardship is essential for their optimal use and accuracy, and interventions can be applied at all phases of the diagnostic process. SUMMARY The aim of this review article is to describe effective approaches to diagnostic stewardship for syndromic molecular panels to ensure appropriate test utilization and quality assured results.
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Affiliation(s)
- Matthew M Hitchcock
- Department of Medicine, Division of Infectious Diseases, Central Virginia VA Health Care System, Richmond, VA, United States
- Department of Internal Medicine, Division of Infectious Diseases, Virginia Commonwealth University School of Medicine, Richmond, VA, United States
| | - Carlos A Gomez
- Department of Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, United States
| | - Joseph Pozdol
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, United States
- Clinical Microbiology Laboratory, Stanford University Medical Center, Palo Alto, CA, United States
| | - Niaz Banaei
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, United States
- Clinical Microbiology Laboratory, Stanford University Medical Center, Palo Alto, CA, United States
- Department of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, United States
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3
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Bulterys PL, Leung NY, Saleem A, Budvytiene I, Pinsky BA, Banaei N. Postpandemic Effects of COVID-19 Shelter-in-Place Orders on the Gastrointestinal Pathogen Landscape. J Clin Microbiol 2023; 61:e0038523. [PMID: 37466426 PMCID: PMC10446857 DOI: 10.1128/jcm.00385-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Affiliation(s)
- Philip L. Bulterys
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - Nicole Y. Leung
- Stanford University School of Medicine, Stanford, California, USA
| | - Atif Saleem
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - Indre Budvytiene
- Clinical Virology Laboratory, Stanford University Medical Center, Stanford, California, USA
| | - Benjamin A. Pinsky
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
- Department of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California, USA
- Clinical Virology Laboratory, Stanford University Medical Center, Stanford, California, USA
| | - Niaz Banaei
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
- Department of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California, USA
- Clinical Microbiology Laboratory, Stanford University Medical Center, Stanford, California, USA
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Hassan EA, Abdel Rehim ASED, Ahmed AO, Salim SMAE, Soliman AMA, Rashed HG, Abd El-Kareem DM. Current insight into enteropathogens in flare-up ulcerative colitis. An observational study. Eur J Gastroenterol Hepatol 2023; 35:711-720. [PMID: 37161967 DOI: 10.1097/meg.0000000000002563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
OBJECTIVE Incidence of ulcerative colitis is globally increased. Enteric infections and their role in ulcerative colitis flares present a common health problem and a unique clinical challenge. We aimed to identify enteropathogens in flared ulcerative colitis patients and their antimicrobial susceptibilities and relation with the disease activity. METHODS Stool samples were collected from 95 patients with ulcerative colitis (17 inactive cases and 78 active cases) according to the Mayo score assessment of ulcerative colitis severity. Enteropathogens were examined using an automated VITEK2 system and FilmArray gastrointestinal pathogen panel. RESULTS Enteric infections were found in 81 patients (85.3%) with a significantly higher percentage in active ulcerative colitis (96.2% vs. 35.3%, P < 0.001). In 78 symptomatic patients, (78.7%) of bacteria as enteroaggregative and enteropathogenic E. coli , (11.5%) parasitic as Cryptosporidium and (7.7%) viral as Norovirus were the most detected microbial pathogens. Mixed, multidrug-resistant organisms (MDROs) and opportunistic infections were reported in 70.7%, 52.9% and 46.7% respectively. Raoultella ornithinolytica was reported for the first time as an enteropathogen in ulcerative colitis flare. Multiple organisms, MDROs, extended-spectrum beta-lactamases-producing and AmpC-resistant bacteria were significantly associated with disease severity. CONCLUSION Identifying enteropathogens especially opportunistic and MDR organisms as a cause of ulcerative colitis flare-ups is a matter of worry increasing their diagnostic and therapeutic burden. Periodic studies evaluating changes in microbial profiles and their antimicrobial susceptibilities are needed to achieve antibiotic stewardship and improve management.
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Affiliation(s)
| | | | | | | | - Asmaa M A Soliman
- Department of Public Health and Community Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt
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Carmon D, Rohana H, Azrad M, Peretz A. The Impact of a Positive Biofire® FilmArray® Gastrointestinal Panel Result on Clinical Management and Outcomes. Diagnostics (Basel) 2023; 13:diagnostics13061094. [PMID: 36980402 PMCID: PMC10046972 DOI: 10.3390/diagnostics13061094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/02/2023] [Accepted: 03/10/2023] [Indexed: 03/17/2023] Open
Abstract
The gold standard diagnostic method for gastrointestinal infections is stool culture, which has limited sensitivity and long turnaround time. Infection diagnosis recently shifted to syndrome-based panel assays. This study employed the FilmArray® Gastrointestinal Panel, which detects 22 pathogens simultaneously, to investigate gastrointestinal infection and pathogen distribution in 91 stool samples of patients hospitalized at the Tzafon Medical Center, Israel, during 2020, and to compare the clinical and demographic data of negative vs. positive samples. Among the 61 positive samples (67%), the most common pathogen was Campylobacter (34.4%). Positive test results were associated with a slightly younger patient age (p = 0.012), significantly higher post-diagnosis use of antibiotics (63.9% vs. 36.7%; p = 0.014), and shorter length of stay and time to discharge (p = 0.035, p = 0.003, respectively) than negative test results. To conclude, the FilmArray® Gastrointestinal Panel enabled the early identification of causative infectious agents and enhanced clinical management and outcomes.
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Affiliation(s)
- David Carmon
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel
| | - Hanan Rohana
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel
- The Clinical Microbiology Laboratory, Tzafon Medical Center, Poriya, Tiberias 1528001, Israel
| | - Maya Azrad
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel
- The Clinical Microbiology Laboratory, Tzafon Medical Center, Poriya, Tiberias 1528001, Israel
| | - Avi Peretz
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel
- The Clinical Microbiology Laboratory, Tzafon Medical Center, Poriya, Tiberias 1528001, Israel
- Correspondence: ; Tel.: +972-4-665-2322
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Lakhan C, Badrie N, Ramsubhag A, Indar L. Detection of Foodborne Pathogens in Acute Gastroenteritis Patient’s Stool Samples Using the BioFire® FilmArray® Gastrointestinal PCR Panel in the Republic of Trinidad and Tobago, West Indies. Microorganisms 2022; 10:microorganisms10081601. [PMID: 36014019 PMCID: PMC9416176 DOI: 10.3390/microorganisms10081601] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 07/29/2022] [Indexed: 11/16/2022] Open
Abstract
In 2009, the burden of illness study for acute gastroenteritis in Trinidad and Tobago highlighted that ~10% of stool samples tested were positive for a foodborne pathogen. The study also noted that limited laboratory screening for pathogens contributed to a lack of etiology as public health hospitals only routinely tested for Salmonella and Shigella, and sometimes for Escherichia coli and Campylobacter. To better understand the foodborne pathogens responsible for acute gastroenteritis, enhanced testing using the BioFire® FilmArray® Gastrointestinal PCR panel was used to screen diarrheal stool samples for 22 pathogens from patients in 2018. The five general public health hospitals (San Fernando, Mt. Hope, Port of Spain, Sangre Grande, and Tobago) were notified of research activities and diarrheal stool samples were collected from all acute gastroenteritis patients. A total of 66 stools were screened and ~30% of samples tested positive for a foodborne pathogen. The current study showed that a much wider range of enteric pathogens were associated with acute gastroenteritis in Trinidad and Tobago than previously reported in 2009. These findings can be used by health officials to guide appropriate interventions, as well as to provide evidence for adoption of the PCR panel detection method at public health hospitals to benefit patient care.
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Affiliation(s)
- Carelene Lakhan
- Department of Food Production, University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Neela Badrie
- Department of Food Production, University of the West Indies, St. Augustine, Trinidad and Tobago
- Correspondence: ; Tel.: +1868-662-2002 (ext. 83211); Fax: +1868-663-9684
| | - Adash Ramsubhag
- Department of Life Sciences, University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Lisa Indar
- The Caribbean Public Health Agency, Port of Spain, Trinidad and Tobago
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Ray LC, Griffin PM, Wymore K, Wilson E, Hurd S, LaClair B, Wozny S, Eikmeier D, Nicholson C, Burzlaff K, Hatch J, Fankhauser M, Kubota K, Huang JY, Geissler A, Payne DC, Tack DM. Changing Diagnostic Testing Practices for Foodborne Pathogens, Foodborne Diseases Active Surveillance Network, 2012-2019. Open Forum Infect Dis 2022; 9:ofac344. [PMID: 35928506 PMCID: PMC9345410 DOI: 10.1093/ofid/ofac344] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Pathogen detection has changed with increased use of culture-independent diagnostic tests (CIDTs). CIDTs do not yield isolates, which are necessary to detect outbreaks using whole-genome sequencing. The Foodborne Diseases Active Surveillance Network (FoodNet) monitors clinical laboratory testing practices to improve interpretation of surveillance data and assess availability of isolates. We describe changes in practices over 8 years. METHODS During 2012-2019, 10 FoodNet sites collected standardized data about practices in clinical laboratories (range, 664-723 laboratories) for select enteric pathogens. We assessed changes in practices. RESULTS During 2012-2019, the percentage of laboratories that used only culture methods decreased, with the largest declines for Vibrio (99%-57%) and Yersinia (99%-60%). During 2019, the percentage of laboratories using only CIDTs was highest for Shiga toxin-producing Escherichia coli (43%), Campylobacter (34%), and Vibrio (34%). From 2015 to 2019, the percentage of laboratories that performed reflex culture after a positive CIDT decreased, with the largest declines for Shigella (75%-42%) and Salmonella (70%-38%). The percentage of laboratories that routinely submitted isolates to a public health laboratory decreased for all bacterial pathogens examined from 2015 to 2019. CONCLUSIONS By increasing use of CIDTs and decreasing reflex culture, clinical laboratories have transferred the burden of isolate recovery to public health laboratories. Until technologies allow for molecular subtyping directly from a patient specimen, state public health laboratories should consider updating enteric disease reporting requirements to include submission of isolates or specimens. Public health laboratories need resources for isolate recovery.
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Affiliation(s)
- Logan C Ray
- Correspondence: Logan C. Ray, 1600 Clifton Road NE, Atlanta, GA 30333 ()
| | - Patricia M Griffin
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Katie Wymore
- California Department of Public Health,Sacramento, California, USA
| | - Elisha Wilson
- Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | - Sharon Hurd
- Connecticut Emerging Infections Program, New Haven, Connecticut, USA
| | | | - Sophia Wozny
- Maryland Department of Health, Baltimore, Maryland, USA
| | - Dana Eikmeier
- Minnesota Department of Health, St. Paul, Minnesota, USA
| | - Cyndy Nicholson
- New Mexico Emerging Infections Program, Albuquerque, New Mexico, USA
| | - Kari Burzlaff
- New York State Department of Health, Buffalo, New York, USA
| | | | | | - Kristy Kubota
- Association of Public Health Laboratories, Silver Spring, Maryland, USA
| | - Jennifer Y Huang
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Aimee Geissler
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Daniel C Payne
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Danielle M Tack
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Berenger BM, Chui L, Ferrato C, Lloyd T, Li V, Pillai DR. Performance of four commercial real-time PCR assays for the detection of bacterial enteric pathogens in clinical samples. Int J Infect Dis 2021; 114:195-201. [PMID: 34700003 DOI: 10.1016/j.ijid.2021.10.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/19/2021] [Accepted: 10/20/2021] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVES Many laboratories use culture-independent diagnostic tests for bacterial gastroenteritis (ie. real-time polymerase chain reaction [RT-PCR]) instead of culture because of better sensitivity, automation, and faster turnaround times. To address some gaps in initial evaluations and lack of intraassay comparisons for many commercial RT-PCRs we compared the ability of four commercially available RT-PCR tests (Ridagene, Fast Track Diagnostics, BD Max, and Prodesse Progastro) to detect five major bacterial enteric pathogens: Campylobacter, Salmonella, Shiga-toxin producing E. coli (STEC), Shigella and Yersinia. METHODS Clinical stool specimens and contrived samples comprising commonly circulating species, serotypes, biovars and/or toxin subtypes were used for the comparison. RESULTS Concordance rates for RT-PCR and culture using culture positive and negative clinical stools were greater than 90% for Campylobacter (97.5-100%), Salmonella (97.5-100%), Shigella (100%) and STEC (90-100%). However, the agreement between RT-PCR and culture for Y. enteroccolitica ranged from 70-90%. For the contrived sample set, stx2f was detected by only 1 of 4 assays. Of note, no assay could detect Yersinia non-enterocolitica and C. upsaliensis. CONCLUSIONS Depending on the prevalence of certain stx sub-types, Yersinia and Campylobacter species in a laboratory's jurisdiction, culture methods remain critical for the detection of these pathogens without further improvement in PCR assays.
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Affiliation(s)
- Byron M Berenger
- South Sector Microbiology, Alberta Precision Laboratories, 3535 Research Road, Calgary, AB, Canada T2L 1Y1; Alberta Public Health Laboratory, Alberta Precision Laboratories, 3300 Hospital Drive NW, Calgary, AB, T2N 4W4; Department of Pathology and Laboratory Medicine, University of Calgary, 3535 Research Road, Calgary, AB, Canada T2L 1Y1.
| | - Linda Chui
- Alberta Public Health Laboratory, Alberta Precision Laboratories, 3300 Hospital Drive NW, Calgary, AB, T2N 4W4; Department of Laboratory Medicine and Pathology, University of Alberta, 116 St. and 85 Ave Edmonton, AB, Canada T6G 2R3.
| | - Christina Ferrato
- Alberta Public Health Laboratory, Alberta Precision Laboratories, 3300 Hospital Drive NW, Calgary, AB, T2N 4W4.
| | - Tracie Lloyd
- South Sector Microbiology, Alberta Precision Laboratories, 3535 Research Road, Calgary, AB, Canada T2L 1Y1.
| | - Vincent Li
- Alberta Public Health Laboratory, Alberta Precision Laboratories, 3300 Hospital Drive NW, Calgary, AB, T2N 4W4.
| | - Dylan R Pillai
- South Sector Microbiology, Alberta Precision Laboratories, 3535 Research Road, Calgary, AB, Canada T2L 1Y1; Department of Pathology and Laboratory Medicine, University of Calgary, 3535 Research Road, Calgary, AB, Canada T2L 1Y1; Department of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, Canada T2N 4N1.
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9
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O'Leary JK, Sleator RD, Lucey B. Cryptosporidium spp. diagnosis and research in the 21 st century. Food Waterborne Parasitol 2021; 24:e00131. [PMID: 34471706 PMCID: PMC8390533 DOI: 10.1016/j.fawpar.2021.e00131] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 08/06/2021] [Accepted: 08/17/2021] [Indexed: 01/01/2023] Open
Abstract
The protozoan parasite Cryptosporidium has emerged as a leading cause of diarrhoeal illness worldwide, posing a significant threat to young children and immunocompromised patients. While endemic in the vast majority of developing countries, Cryptosporidium also has the potential to cause waterborne epidemics and large scale outbreaks in both developing and developed nations. Anthroponontic and zoonotic transmission routes are well defined, with the ingestion of faecally contaminated food and water supplies a common source of infection. Microscopy, the current diagnostic mainstay, is considered by many to be suboptimal. This has prompted a shift towards alternative diagnostic techniques in the advent of the molecular era. Molecular methods, particularly PCR, are gaining traction in a diagnostic capacity over microscopy in the diagnosis of cryptosporidiosis, given the laborious and often tedious nature of the latter. Until now, developments in the field of Cryptosporidium detection and research have been somewhat hampered by the intractable nature of this parasite. However, recent advances in the field have taken the tentative first steps towards bringing Cryptosporidium research into the 21st century. Herein, we provide a review of these advances.
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Affiliation(s)
- Jennifer K. O'Leary
- Department of Biological Sciences, Munster Technological University, Bishopstown Campus, Cork, Ireland
| | - Roy D. Sleator
- Department of Biological Sciences, Munster Technological University, Bishopstown Campus, Cork, Ireland
| | - Brigid Lucey
- Department of Biological Sciences, Munster Technological University, Bishopstown Campus, Cork, Ireland
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McElheny KD, Little D, Taylor D, Manzi JE. Communicable Illness Mitigation Strategies for Traveling Elite Sporting Organizations. Sports Health 2021; 14:532-537. [PMID: 34292110 DOI: 10.1177/19417381211032226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
CONTEXT Transmission of communicable diseases observed in sporting organizations is often preventable. Early detection, isolation, and treatment can significantly diminish time lost. Until recently, there has been a paucity of standardized guidelines outlining feasible, preventable measures to protect both athletes and staff from contagious illnesses. Therefore, the purpose of this narrative was to highlight optimal prevention practices for transmission mitigation, with a particular focus on hygiene activity and travel considerations in professional sporting organizations. EVIDENCE ACQUISITION Current recommendations from the Centers for Disease Control and Prevention and peer-reviewed journals. STUDY DESIGN Clinical review. LEVEL OF EVIDENCE Level 5. RESULTS Communicable illness prevention strategies begin at the level of sufficient personal hygiene practices. Common area surface cleaning recommendations, including shared equipment sanitization between usage as well as designated equipment use to specific athletes, should be considered to minimize cross-contamination, in particular, for liked-position players. Intelligent design for shared areas can include redistributing the layout of communal spaces, most feasibly, spreading locker designation a minimum distance of 6 ft from one another. Travel considerations can include placing most susceptible passengers closest to window seating, boarding last and exiting first. Team physicians should have knowledge of essential personnel medical histories in an effort to risk stratify staff members and players in the setting of communicable disease. CONCLUSION Providing a framework for illness management and prevention is important when considering the effects on player health, missed time, performance, and overall cost. Containment of commonly observed communicable illnesses can be optimized with sufficient personal hygiene practices, common area surface cleaning recommendations, intelligent design for shared areas, travel and hotel considerations, as well as appropriate screening tools and isolation techniques. STRENGTH OF RECOMMENDATION TAXONOMY (SORT) B.
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Affiliation(s)
- Kathryn D McElheny
- Hospital for Special Surgery, New York, New York.,New York Mets Baseball Club, Queens, New York
| | - Dean Little
- New York Mets Baseball Club, Queens, New York
| | - David Taylor
- United States Olympic and Paralympics Committee, Colorado Springs, Colorado.,Golden State Warriors Basketball Club, San Francisco, California
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11
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Bulterys PL, Leung NY, Saleem A, Budvytiene I, Banaei N. Impact of COVID-19 Shelter-in-Place Order on Transmission of Gastrointestinal Pathogens in Northern California. J Clin Microbiol 2021; 59:e0044921. [PMID: 33846223 PMCID: PMC8218763 DOI: 10.1128/jcm.00449-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Philip L. Bulterys
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - Nicole Y. Leung
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Atif Saleem
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - Indre Budvytiene
- Clinical Microbiology Laboratory, Stanford University Medical Center, Stanford, California, USA
| | - Niaz Banaei
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
- Department of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California, USA
- Clinical Microbiology Laboratory, Stanford University Medical Center, Stanford, California, USA
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12
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Decuir M, Fowler RC, Cebelinski E, Smith K, Boxrud D, Medus C. Evidence of False Positivity for Vibrio Species Tested by Gastrointestinal Multiplex PCR Panels, Minnesota, 2016-2018. Open Forum Infect Dis 2021; 8:ofab247. [PMID: 34141820 DOI: 10.1093/ofid/ofab247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/12/2021] [Indexed: 02/04/2023] Open
Abstract
Background Syndromic gastrointestinal multiplex polymerase chain reaction (PCR) panels (GMPPs) are used by an increasing number of clinical laboratories to identify enteric pathogens. Vibrio species are included on GMPPs, but because of the low prevalence of vibriosis, performance characteristics for these panels have been difficult to measure. Methods All Vibrio spp. cases identified by GMPPs in Minnesota during 2016-2018 (n = 100) were assessed to identify differences between culture-confirmed cases and those that were PCR-positive only. Results Overall, 47% of cases had Vibrio species recovered by culture. Two GMPPs were used in Minnesota, Verigene EPT and FilmArray GIP, and the recovery rate of Vibrio spp. was significantly different between these platforms (Verigene EPT 63%, compared with FilmArray GIP 28%). No distinct seasonality was identified among GMPP-positive, culture-negative cases, whereas culture-confirmed case incidence peaked during July and August. Among cases with no other pathogen detected by the GMPP, confirmed cases reported a lower rate of bloody diarrhea (odds ratio [OR], 0.7; P = .004) and were less likely to have a symptom duration >14 days (OR, 0.3; P = .04). Confirmed cases were also more likely to include reports of consuming food items typically associated with Vibrio spp. infection or to have another likely source of infection (eg, international travel or contact with an untreated body of fresh or salt water or marine life; OR, 9.6; P = .001). Conclusions The combined findings indicate that cases identified by GMPP that did not have culture confirmation were less likely to include symptoms or exposures consistent with vibriosis. These findings emphasize the need for improvements to testing platform specificity and the importance of combining clinical and exposure information when diagnosing an infection. This study underscores the importance of maintaining the ability to culture Vibrio species to aid in accurate diagnoses.
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Affiliation(s)
- Marijke Decuir
- Foodborne, Waterborne, Vectorborne, and Zoonotic Diseases Section, Minnesota Department of Health, Saint Paul, Minnesota, USA
| | - Randal C Fowler
- Laboratory Leadership Service, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Elizabeth Cebelinski
- Public Health Laboratory, Minnesota Department of Health, Saint Paul, Minnesota, USA
| | - Kirk Smith
- Foodborne, Waterborne, Vectorborne, and Zoonotic Diseases Section, Minnesota Department of Health, Saint Paul, Minnesota, USA
| | - David Boxrud
- Public Health Laboratory, Minnesota Department of Health, Saint Paul, Minnesota, USA
| | - Carlota Medus
- Foodborne, Waterborne, Vectorborne, and Zoonotic Diseases Section, Minnesota Department of Health, Saint Paul, Minnesota, USA
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Ruzante JM, Olin K, Munoz B, Nawrocki J, Selvarangan R, Meyers L. Real-time gastrointestinal infection surveillance through a cloud-based network of clinical laboratories. PLoS One 2021; 16:e0250767. [PMID: 33930062 PMCID: PMC8087049 DOI: 10.1371/journal.pone.0250767] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 04/14/2021] [Indexed: 02/04/2023] Open
Abstract
Acute gastrointestinal infection (AGI) represents a significant public health concern. To control and treat AGI, it is critical to quickly and accurately identify its causes. The use of novel multiplex molecular assays for pathogen detection and identification provides a unique opportunity to improve pathogen detection, and better understand risk factors and burden associated with AGI in the community. In this study, de-identified results from BioFire® FilmArray® Gastrointestinal (GI) Panel were obtained from January 01, 2016 to October 31, 2018 through BioFire® Syndromic Trends (Trend), a cloud database. Data was analyzed to describe the occurrence of pathogens causing AGI across United States sites and the relative rankings of pathogens monitored by FoodNet, a CDC surveillance system were compared. During the period of the study, the number of tests performed increased 10-fold and overall, 42.6% were positive for one or more pathogens. Seventy percent of the detections were bacteria, 25% viruses, and 4% parasites. Clostridium difficile, enteropathogenic Escherichia coli (EPEC) and norovirus were the most frequently detected pathogens. Seasonality was observed for several pathogens including astrovirus, rotavirus, and norovirus, EPEC, and Campylobacter. The co-detection rate was 10.2%. Enterotoxigenic E. coli (ETEC), Plesiomonas shigelloides, enteroaggregative E. coli (EAEC), and Entamoeba histolytica were detected with another pathogen over 60% of the time, while less than 30% of C. difficile and Cyclospora cayetanensis were detected with another pathogen. Positive correlations among co-detections were found between Shigella/Enteroinvasive E. coli with E. histolytica, and ETEC with EAEC. Overall, the relative ranking of detections for the eight GI pathogens monitored by FoodNet and BioFire Trend were similar for five of them. AGI data from BioFire Trend is available in near real-time and represents a rich data source for the study of disease burden and GI pathogen circulation in the community, especially for those pathogens not often targeted by surveillance.
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Affiliation(s)
- Juliana M Ruzante
- Center for Environmental Health, Risk and Sustainability, RTI International, Research Triangle Park, North Carolina, United States of America
| | - Katherine Olin
- Biomathematics, BioFire Diagnostics, Salt Lake City, Utah, United States of America
| | - Breda Munoz
- Center for Environmental Health, Risk and Sustainability, RTI International, Research Triangle Park, North Carolina, United States of America
| | - Jeff Nawrocki
- Biomathematics, BioFire Diagnostics, Salt Lake City, Utah, United States of America
| | - Rangaraj Selvarangan
- Department of Pathology and Laboratory Medicine, Children's Mercy Kansas City, Kansas City, Missouri, United States of America
| | - Lindsay Meyers
- Medical Data Systems, BioFire Diagnostics, Salt Lake City, Utah, United States of America
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Performance Evaluation of the Novodiag Bacterial GE+ Multiplex PCR Assay. J Clin Microbiol 2020; 58:JCM.01033-20. [PMID: 32719031 DOI: 10.1128/jcm.01033-20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 07/15/2020] [Indexed: 11/20/2022] Open
Abstract
The bacteriological diagnosis of intestinal bacterial infections has historically been based on culture on agar plates. However, culture may lack sensitivity, and some enteropathogens, such as pathovars of Escherichia coli, may escape routine diagnosis. Our goal was to evaluate the analytical performance of the Novodiag Bacterial GE+ kit for the detection of enteropathogenic bacteria in acute community diarrhea. We included 251 stools in this study (198 retrospective and 53 prospective). The analytical performance was calculated using a composite reference standard (CRS) in the absence of a perfect gold standard (lack of sensitivity of culture). The CRS was defined as positive if culture was positive or, in case of a negative culture, if the BD Max extended enteric bacterial panel and/or other real-time PCR (RT-PCR) tests were positive. Of the 251 samples, 200 were positive, and 51 were negative. Overall sensitivities of the Novodiag Bacterial GE+ kit for Campylobacter sp., Salmonella sp., Shigella sp./enteroinvasive E. coli (EIEC), Yersinia enterocolitica, enterohemorrhagic E. coli (EHEC), and enterotoxigenic E. coli (ETEC) ranged from 98.98 to 100%, specificities ranged from 98.08 to 100%, positive predictive values (PPVs) ranged from 88.24 to 100%, and negative predictive values (NVPs) ranged from 99.36 to 100%. The analytical performance of the Novodiag Bacterial GE+ kit is excellent. It can be used as a routine tool in the rapid diagnosis of bacterial gastroenteritis. Despite the eNAT tube dilution of the primary sample, the detection of Salmonella sp. and EHEC was perfect. The kit has the advantage of only detecting pathogenic Y. enterocolitica Its performance for Campylobacter is very satisfactory.
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Abstract
Enterotoxigenic Escherichia coli (ETEC) is a well-established cause of traveller's diarrhoea and occasional domestic foodborne illness outbreaks in the USA. Although ETEC are not detected by conventional stool culture methods used in clinical laboratories, syndromic culture-independent diagnostic tests (CIDTs) capable of detecting ETEC have become increasingly prevalent in the last decade. This study describes the epidemiology of ETEC infections reported to the Minnesota Department of Health (MDH) during 2016–2017. ETEC-positive stool specimens were submitted to MDH to confirm the presence of ETEC DNA by polymerase chain reaction (PCR). Cases were interviewed to ascertain illness and exposures. Contemporaneous Salmonella cases were used as a comparison group in a case-case comparison analysis of risk factors. Of 222 ETEC-positive specimens received by MDH, 108 (49%) were concordant by PCR. ETEC was the sixth most frequently reported bacterial enteric pathogen among a subset of CIDT-positive specimens. Sixty-nine (64%) laboratory-confirmed cases had an additional pathogen codetected with ETEC, including enteroaggregative E. coli (n = 40) and enteropathogenic E. coli (n = 39). Although travel is a risk factor for ETEC infection, only 43% of cases travelled internationally, providing evidence for ETEC as an underestimated source of domestically acquired enteric illness in the USA.
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Torres-Miranda D, Akselrod H, Karsner R, Secco A, Silva-Cantillo D, Siegel MO, Roberts AD, Simon GL. Use of BioFire FilmArray gastrointestinal PCR panel associated with reductions in antibiotic use, time to optimal antibiotics, and length of stay. BMC Gastroenterol 2020; 20:246. [PMID: 32727381 PMCID: PMC7392718 DOI: 10.1186/s12876-020-01394-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 07/22/2020] [Indexed: 12/16/2022] Open
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.
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Affiliation(s)
- Daisy Torres-Miranda
- Division of Infectious Diseases, George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Avenue NW, Washington, DC, 20037, USA
| | - Hana Akselrod
- Division of Infectious Diseases, George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Avenue NW, Washington, DC, 20037, USA.
| | - Ryan Karsner
- Division of Infectious Diseases, George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Avenue NW, Washington, DC, 20037, USA
| | - Alessandra Secco
- Division of Infectious Diseases, George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Avenue NW, Washington, DC, 20037, USA
| | - Diana Silva-Cantillo
- Division of Infectious Diseases, George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Avenue NW, Washington, DC, 20037, USA
| | - Marc O Siegel
- Division of Infectious Diseases, George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Avenue NW, Washington, DC, 20037, USA
| | - Afsoon D Roberts
- Division of Infectious Diseases, George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Avenue NW, Washington, DC, 20037, USA
| | - Gary L Simon
- Division of Infectious Diseases, George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Avenue NW, Washington, DC, 20037, USA
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18
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Diarrhoeal events can trigger long-term Clostridium difficile colonization with recurrent blooms. Nat Microbiol 2020; 5:642-650. [PMID: 32042128 DOI: 10.1038/s41564-020-0668-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 01/07/2020] [Indexed: 11/08/2022]
Abstract
Although Clostridium difficile is widely considered an antibiotic- and hospital-associated pathogen, recent evidence indicates that this is an insufficient depiction of the risks and reservoirs. A common thread that links all major risk factors of infection is their association with gastrointestinal disturbances, but this relationship to C. difficile colonization has never been tested directly. Here, we show that disturbances caused by diarrhoeal events trigger susceptibility to C. difficile colonization. Using survey data of the human gut microbiome, we detected C. difficile colonization and blooms in people recovering from food poisoning and Vibrio cholerae infections. Carriers remained colonized for year-long time scales and experienced highly variable patterns of C. difficile abundance, where increased shedding over short periods of 1-2 d interrupted week-long periods in which C. difficile was undetectable. Given that short shedding events were often linked to gastrointestinal disturbances, our results help explain why C. difficile is frequently detected as a co-infecting pathogen in patients with diarrhoea. To directly test the impact of diarrhoea on susceptibility to colonization, we developed a mouse model of variable disturbance intensity, which allowed us to monitor colonization in the absence of disease. As mice exposed to avirulent C. difficile spores ingested increasing quantities of laxatives, more individuals experienced C. difficile blooms. Our results indicate that the likelihood of colonization is highest in the days immediately following acute disturbances, suggesting that this could be an important window during which transmission could be interrupted and the incidence of infection lowered.
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Machiels JD, Cremers AJH, van Bergen-Verkuyten MCGT, Paardekoper-Strijbosch SJM, Frijns KCJ, Wertheim HFL, Rahamat-Langendoen J, Melchers WJG. Impact of the BioFire FilmArray gastrointestinal panel on patient care and infection control. PLoS One 2020; 15:e0228596. [PMID: 32027698 PMCID: PMC7004333 DOI: 10.1371/journal.pone.0228596] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 01/18/2020] [Indexed: 12/20/2022] Open
Abstract
Objectives Conventional routine PCR testing for gastrointestinal infections is generally based on pathogen related panels specifically requested by clinicians and can be erroneous and time consuming. The BioFire FilmArray gastrointestinal (GI) panel combines 22 pathogens into a single cartridge-based test on a random-access system, thereby reducing the turnaround time to less than 2 hours. We described the clinical impact of implementing the BioFire FilmArray on patients with gastroenteritis in our hospital. Methods Patients attending a Dutch tertiary care center (Radboud University Medical Center), from whom stool samples were obtained, were eligible for inclusion. The clinicians selected one or a combination of different routinely performed PCR panels (bacterial panel, viral panel, clostridium testing, and three parasitic panels) based on clinical history and symptoms. All samples were in parallel tested with the FilmArray. We retrospectively collected patient data regarding infection control and patient management to assess the potential impact of implementing the FilmArray. Results In total 182 patients were included. Routine PCR detected one or more pathogens in 52 (28.6%) patients compared to 72 (39.6%) using the FilmArray. Turnaround time (including transport) decreased from median 53 hours for the routine PCR to 16 hours for the FilmArray. Twenty-six patients could have been removed from isolation 29 hours sooner, 3.6 antibiotic days could have been saved and in five patients additional imaging testing (including colonoscopies) could have been prevented. Conclusion The theoretical implementation of the BioFire FilmArray GI panel in patients with clinical suspicion of gastroenteritis resulted in a significant better patient management.
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Affiliation(s)
- Julian D. Machiels
- Department of Medical Microbiology & Radboudumc Center for Infectious Diseases, Radboud university medical center, Nijmegen, The Netherlands
- * E-mail:
| | - Amelieke J. H. Cremers
- Department of Medical Microbiology & Radboudumc Center for Infectious Diseases, Radboud university medical center, Nijmegen, The Netherlands
| | | | - Sandra J. M. Paardekoper-Strijbosch
- Department of Medical Microbiology & Radboudumc Center for Infectious Diseases, Radboud university medical center, Nijmegen, The Netherlands
| | - Kelly C. J. Frijns
- Department of Medical Microbiology & Radboudumc Center for Infectious Diseases, Radboud university medical center, Nijmegen, The Netherlands
| | - Heiman F. L. Wertheim
- Department of Medical Microbiology & Radboudumc Center for Infectious Diseases, Radboud university medical center, Nijmegen, The Netherlands
| | - Janette Rahamat-Langendoen
- Department of Medical Microbiology & Radboudumc Center for Infectious Diseases, Radboud university medical center, Nijmegen, The Netherlands
| | - Willem J. G. Melchers
- Department of Medical Microbiology & Radboudumc Center for Infectious Diseases, Radboud university medical center, Nijmegen, The Netherlands
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20
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Leli C, Di Matteo L, Gotta F, Vay D, Cavallo V, Mazzeo R, Busso S, Carrabba L, Rocchetti A. Evaluation of a multiplex gastrointestinal PCR panel for the aetiological diagnosis of infectious diarrhoea. Infect Dis (Lond) 2019; 52:114-120. [DOI: 10.1080/23744235.2019.1688861] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Christian Leli
- Microbiology Laboratory, SS. Antonio e Biagio e C. Arrigo Hospital, Alessandria, Italy
| | - Luigi Di Matteo
- Microbiology Laboratory, SS. Antonio e Biagio e C. Arrigo Hospital, Alessandria, Italy
| | - Franca Gotta
- Microbiology Laboratory, SS. Antonio e Biagio e C. Arrigo Hospital, Alessandria, Italy
| | - Daria Vay
- Pathology Unit, SS. Antonio e Biagio e C. Arrigo Hospital, Alessandria, Italy
| | - Valeria Cavallo
- Microbiology Laboratory, SS. Antonio e Biagio e C. Arrigo Hospital, Alessandria, Italy
| | - Roberta Mazzeo
- Microbiology Laboratory, SS. Antonio e Biagio e C. Arrigo Hospital, Alessandria, Italy
| | - Simone Busso
- Microbiology Laboratory, SS. Antonio e Biagio e C. Arrigo Hospital, Alessandria, Italy
| | - Laura Carrabba
- Microbiology Laboratory, SS. Antonio e Biagio e C. Arrigo Hospital, Alessandria, Italy
| | - Andrea Rocchetti
- Microbiology Laboratory, SS. Antonio e Biagio e C. Arrigo Hospital, Alessandria, Italy
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21
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Cintrón M, O'Sullivan B, Babady NE, Tang YW. Vibrio cholera and V. parahaemolyticus coinfection in an oncology patient with gastroenteritis. Diagn Microbiol Infect Dis 2019; 96:114927. [PMID: 31740171 DOI: 10.1016/j.diagmicrobio.2019.114927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 10/28/2019] [Accepted: 10/31/2019] [Indexed: 10/25/2022]
Abstract
Vibrio-related gastroenteritis in the United States is mostly associated with the consumption of raw or improperly cooked seafood. We describe a case of a stage IV lung adenocarcinoma patient who became ill after eating crab while visiting Upstate New York. Molecular testing and culture confirmed a coinfection with V. parahaemolyticus and a nontoxigenic strain V. cholera.
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Affiliation(s)
- Melvilí Cintrón
- Clinical Microbiology Service, Department of Laboratory Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Barbara O'Sullivan
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York, USA; Rockefeller University Hospital, New York, New York, USA
| | - N Esther Babady
- Clinical Microbiology Service, Department of Laboratory Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York, USA; Infectious Diseases Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Yi-Wei Tang
- Clinical Microbiology Service, Department of Laboratory Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York, USA; Infectious Diseases Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York, USA; Department of Pathology and Laboratory Medicine, Weill Medical College of Cornell University, New York, New York, USA.
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22
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Redli PM, Wanzenried A, Huder JB, Berger C, Berlinger L, Capaul R, Böni J, Zbinden A. Evaluation of the RIDA®GENE RT-PCR assays for detection of sapovirus, astrovirus, adenovirus, and rotavirus in stool samples of adults in Switzerland. Diagn Microbiol Infect Dis 2019; 96:114924. [PMID: 31757559 DOI: 10.1016/j.diagmicrobio.2019.114924] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 10/05/2019] [Accepted: 10/29/2019] [Indexed: 12/15/2022]
Abstract
Sapovirus (SaV) and astrovirus (AstV) increasingly are recognized as cause of acute viral gastroenteritis (AGE). We evaluated the real-time RT-PCR assays RIDA®GENE SaV and viral stool panel II (RGN RT-PCR) for detection of SaV, AstV, adenovirus (AdV) F40/41 and rotavirus (RoV) in clinical stool samples (n = 69). Results were compared with reference singleplex RT-PCRs. The sensitivity for SaV, AstV and RoV are 100%, the specificity ranges from 98.1% to 100%. In 10 out of 11 AdV (all types) samples, the RGN RT-PCR for AdV F40/41 displayed negative results. Retrospectively, 196 stool specimens from adult patients previously tested negative for norovirus (NoV) were analyzed. In about 10% of NoV-negative stool samples, AdV (n = 9), RoV (n = 6), AstV (n = 3) or SaV (n = 3) were found. The RGN RT-PCR assays are useful for detection of enteric viruses other than NoV. This study emphasizes the need for further testing of NoV-negative stool samples in patients with AGE.
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Affiliation(s)
- Patrick M Redli
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland.
| | - Adrian Wanzenried
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland.
| | - Jon B Huder
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland.
| | - Christoph Berger
- Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Zurich, Switzerland.
| | | | - Riccarda Capaul
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland.
| | - Jürg Böni
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland.
| | - Andrea Zbinden
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland.
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Vaughn VM, Szymczak JE, Newton DW, Fakih MG. Addressing the Overuse of Cultures to Optimize Patient Care. Ann Intern Med 2019; 171:S73-S74. [PMID: 31569221 DOI: 10.7326/m18-3442] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Valerie M Vaughn
- Patient Safety Enhancement Program, University of Michigan and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (V.M.V.)
| | - Julia E Szymczak
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (J.E.S.)
| | - Duane W Newton
- Clinical Microbiology Laboratory, Department of Pathology, Michigan Medicine, Ann Arbor, Michigan (D.W.N.)
| | - Mohamad G Fakih
- Care Excellence, Ascension Healthcare, St. Louis, Missouri (M.G.F.)
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Hannet I, Engsbro AL, Pareja J, Schneider UV, Lisby JG, Pružinec-Popović B, Hoerauf A, Parčina M. Multicenter evaluation of the new QIAstat Gastrointestinal Panel for the rapid syndromic testing of acute gastroenteritis. Eur J Clin Microbiol Infect Dis 2019; 38:2103-2112. [DOI: 10.1007/s10096-019-03646-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 07/15/2019] [Indexed: 12/17/2022]
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Comparative Evaluation of Enteric Bacterial Culture and a Molecular Multiplex Syndromic Panel in Children with Acute Gastroenteritis. J Clin Microbiol 2019; 57:JCM.00205-19. [PMID: 30971465 DOI: 10.1128/jcm.00205-19] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 04/01/2019] [Indexed: 12/31/2022] Open
Abstract
Although enteric multianalyte syndromic panels are increasingly employed, direct comparisons with traditional methods and the inclusion of host phenotype correlations are limited. Luminex xTAG gastrointestinal pathogen panel (GPP) and culture results are highly concordant. However, phenotypic and microbiological confirmatory testing raises concerns regarding the accuracy of the GPP, especially for Salmonella spp. A total of 3,089 children with gastroenteritis submitted stool specimens, rectal swab specimens, and clinical data. The primary outcome was bacterial pathogen detection agreement for shared targets between culture and the Luminex xTAG GPP. Secondary analyses included phenotype assessment, additional testing of GPP-negative/culture-positive isolate suspensions with the GPP, and in-house and commercial confirmatory nucleic acid testing of GPP-positive/culture-negative extracts. The overall percent agreement between technologies was >99% for each pathogen. Salmonella spp. were detected in specimens from 64 participants: 12 (19%) by culture only, 9 (14%) by GPP only, and 43 (67%) by both techniques. Positive percent agreement for Salmonella spp. was 78.2% (95% confidence interval [CI], 64.6%, 87.8%). Isolate suspensions from the 12 participants with specimens GPP negative/culture positive for Salmonella tested positive by GPP. Specimens GPP positive/culture negative for Salmonella originated in younger children with less diarrhea and more vomiting. GPP-positive/culture-negative specimen extracts tested positive using additional assays for 0/2 Campylobacter-positive specimens, 0/4 Escherichia coli O157-positive specimens, 0/9 Salmonella-positive specimens, and 2/3 Shigella-positive specimens. For both rectal swab and stool samples, the median cycle threshold (CT ) values, determined using quantitative PCR, were higher for GPP-negative/culture-positive samples than for GPP-positive/culture-positive samples (for rectal swabs, 36.9 [interquartile range {IQR}, 33.7, 37.1] versus 30.0 [IQR, 26.2, 33.2], respectively [P = 0.002]; for stool samples, 36.9 [IQR, 33.7, 37.1] versus 29.0 [IQR, 24.8, 30.8], respectively [P = 0.001]). GPP and culture have excellent overall agreement; however, for specific pathogens, GPP is less sensitive than culture and, notably, identifies samples false positive for Salmonella spp.
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26
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Hardwiring diagnostic stewardship using electronic ordering restrictions for gastrointestinal pathogen testing. Infect Control Hosp Epidemiol 2019; 40:668-673. [PMID: 31012405 DOI: 10.1017/ice.2019.78] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To evaluate the impact of a hard stop in the electronic health record (EHR) on inappropriate gastrointestinal pathogen panel testing (GIPP). DESIGN We used a quasi-experimental study to evaluate testing before and after the implementation of an EHR alert to stop inappropriate GIPP ordering. SETTING Midwest academic medical center. PARTICIPANTS Hospitalized patients with diarrhea for which GIPP testing was ordered, between January 2016 through March 2017 (period 1) and April 2017 through June 2018 (period 2). INTERVENTION A hard stop in the EHR prevented clinicians from ordering a GIPP more than once per admission or in patients hospitalized for >72 hours. RESULTS During period 1, 1,587 GIPP tests were ordered over 212,212 patient days, at a rate of 7.48 per 1,000 patient days. In period 2, 1,165 GIPP tests were ordered over 222,343 patient days, at a rate of 5.24 per 1,000 patient days. The Poisson model estimated a 30% reduction in total GIPP ordering rates between the 2 periods (relative risk, 0.70; 95% confidence interval [CI], 0.63-0.78; P 72 hours.
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27
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Clark SD, Sidlak M, Mathers AJ, Poulter M, Platts-Mills JA. Clinical Yield of a Molecular Diagnostic Panel for Enteric Pathogens in Adult Outpatients With Diarrhea and Validation of Guidelines-Based Criteria for Testing. Open Forum Infect Dis 2019; 6:ofz162. [PMID: 31041357 PMCID: PMC6483309 DOI: 10.1093/ofid/ofz162] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 03/26/2019] [Indexed: 12/19/2022] Open
Abstract
Background Molecular diagnostic panels for enteric pathogens offer increased sensitivity and reduced turnaround time. However, many pathogen detections do not change clinical management, and the cost is substantial. Methods We performed a retrospective chart review of adult outpatients with diarrhea at the University of Virginia who had samples tested by the FilmArray Gastrointestinal Panel (BioFire Diagnostics, Salt Lake City, UT) to identify the clinical yield and to validate the clinical criteria for testing recommended in the 2017 Infectious Diseases Society of America (IDSA) guidelines. Results We analyzed 629 tests sent from adult outpatients with diarrhea between March 23, 2015, and July 18, 2016. A pathogen was detected in 127 of 629 specimens (20.2%). The most common pathogens were enteropathogenic Escherichia coli (47, 7.5%), norovirus (24, 3.8%), enteroaggregative E. coli (14, 2.2%), Campylobacter (9, 1.4%), and Salmonella (9; 1.4%). The clinical yield of testing was low, with antimicrobial treatment clearly indicated for only 18 subjects (2.9%) and any change in clinical management indicated for 33 subjects (5.2%). Following the clinical criteria for diagnostic testing from the 2017 IDSA guidelines, which suggest diagnostic testing for patients with fever, abdominal pain, blood in stool, or an immunocompromising condition, would have reduced testing by 32.3% without significantly reducing the clinical yield (sensitivity, 97.0%; 95% confidence interval [CI], 84.2%-99.9%; negative predictive value, 99.5%; 95% CI, 97.3%-100.0%). Conclusions The clinical yield of molecular diagnostic testing in this population was low. Compliance with IDSA guidelines in adult outpatients with diarrhea could reduce testing by approximately one-third.
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Affiliation(s)
- Stephen D Clark
- Cecil G. Sheps Center for Health Services Research and Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Michael Sidlak
- Clinical Microbiology, Department of Pathology, University of Virginia Health System, Charlottesville, Virginia
| | - Amy J Mathers
- Clinical Microbiology, Department of Pathology, University of Virginia Health System, Charlottesville, Virginia.,Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia
| | - Melinda Poulter
- Clinical Microbiology, Department of Pathology, University of Virginia Health System, Charlottesville, Virginia
| | - James A Platts-Mills
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia
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Axelrad JE, Freedberg DE, Whittier S, Greendyke W, Lebwohl B, Green DA. Impact of Gastrointestinal Panel Implementation on Health Care Utilization and Outcomes. J Clin Microbiol 2019; 57:JCM.01775-18. [PMID: 30651393 PMCID: PMC6425162 DOI: 10.1128/jcm.01775-18] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 01/02/2019] [Indexed: 02/06/2023] Open
Abstract
PCR-based multiplex gastrointestinal (GI) pathogen panels have started to replace stool culture and ova and parasite exam as a rapid and accurate means of diagnosing acute gastroenteritis. However, there are limited data on the impact of panel testing on patient outcomes. The objective of this study was to evaluate the management and health care utilization of patients following GI panel compared with conventional stool testing. We performed a retrospective comparative analysis of 9,402 patients who underwent testing with the FilmArray GI panel from March 2015 through May 2017 and 5,986 patients who underwent conventional stool testing from December 2012 through February 2015. GI panel was positive in 2,746 exams (29.2%) compared with 246 exams (4.1%) with conventional testing. Within 30 days following stool testing, compared with patients who received a conventional stool test, patients who received a GI panel were less likely to undergo any endoscopic procedure (8.4% GI panel versus 9.6% stool culture, P = 0.008) or any abdominal radiology (29.4% GI panel versus 31.7%, P = 0.002). Within 14 days following stool testing, patients who received a GI panel were less likely to be prescribed any antibiotic (36.2% GI panel versus 40.9%, P < 0.001). The implementation of multiplex PCR stool testing was associated with a reduction in the utilization of endoscopy, abdominal radiology, and antibiotic prescribing.
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Affiliation(s)
- Jordan E Axelrad
- Division of Gastroenterology, Department of Medicine, NYU Langone Health, New York, New York, USA
- Division of Digestive & Liver Diseases, Columbia University Medical Center, New York, New York, USA
| | - Daniel E Freedberg
- Division of Digestive & Liver Diseases, Columbia University Medical Center, New York, New York, USA
| | - Susan Whittier
- Department of Pathology & Cell Biology, Columbia University Medical Center, New York, New York, USA
| | - William Greendyke
- Division of Infectious Diseases, Columbia University Medical Center, New York, New York, USA
| | - Benjamin Lebwohl
- Division of Digestive & Liver Diseases, Columbia University Medical Center, New York, New York, USA
| | - Daniel A Green
- Department of Pathology & Cell Biology, Columbia University Medical Center, New York, New York, USA
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Zbinden A. [Acute Viral Gastroenteritis: Viruses Other Than Norovirus]. PRAXIS 2019; 108:335-339. [PMID: 30940042 DOI: 10.1024/1661-8157/a003182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Acute Viral Gastroenteritis: Viruses Other Than Norovirus Abstract. Norovirus is the leading cause of acute viral gastroenteritis. Norovirus is highly contagious, thus outbreaks of norovirus in hospitals and long-term care facilities are feared. Usually, stool samples of patients with a potentially viral gastroenteritis are first checked for the presence of norovirus. In recent years, sapovirus and astrovirus were increasingly reported as cause of acute gastroenteritis. Outbreaks of acute viral gastroenteritis caused by sapovirus or astrovirus are hardly distinguishable from those caused by norovirus because of a similar clinical presentation. Molecular analyses of stool specimen are needed for accurate diagnosis of the viral cause of acute gastroenteritis. It is worth to further investigate stool samples of patients suspected of acute viral gastroenteritis not only for norovirus, but also for sapovirus and astrovirus.
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Affiliation(s)
- Andrea Zbinden
- 1 Institut für Medizinische Virologie, Universität Zürich
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Schmitz JE, Tang YW. The GenMark ePlex ®: another weapon in the syndromic arsenal for infection diagnosis. Future Microbiol 2018; 13:1697-1708. [PMID: 30547684 DOI: 10.2217/fmb-2018-0258] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
As one of the most recent additions to the syndromic testing landscape, the ePlex® platform by GenMark Diagnostics is a system that combines the manufacturer's signature electrochemical detection technology with updated microfluidics, providing a new option for multiplex testing that is both rapid and requires minimal hands-on steps. In this review, we detail the ePlex platform and its current/future syndromic panels, with a particular focus on the respiratory pathogen panel - the platform's first assay to undergo clinical trials and receive regulatory approval in the USA. By keeping informed of these ever-expanding laboratory options, clinicians and microbiologists can stay positioned at the forefront of infectious disease diagnosis.
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Affiliation(s)
- Jonathan E Schmitz
- Department of Pathology, Microbiology, & Immunology, Vanderbilt University Medical Center & School of Medicine, Nashville, TN 37232, USA
| | - Yi-Wei Tang
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065 USA.,Department of Pathology & Laboratory Medicine, Weill Cornell Medical College, New York, NY 10065 USA
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31
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Searns JB, Robinson CC, Wei Q, Yuan J, Hamilton S, Pretty K, Donaldson N, Parker SK, Dominguez SR. Validation of a novel molecular diagnostic panel for pediatric musculoskeletal infections: Integration of the Cepheid Xpert MRSA/SA SSTI and laboratory-developed real-time PCR assays for clindamycin resistance genes and Kingella kingae detection. J Microbiol Methods 2018; 156:60-67. [PMID: 30527965 DOI: 10.1016/j.mimet.2018.12.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 12/06/2018] [Accepted: 12/07/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Pathogen detection in pediatric patients with musculoskeletal infections relies on conventional bacterial culture, which is slow and can delay antimicrobial optimization. The ability to rapidly identify causative agents and antimicrobial resistance genes in these infections may improve clinical care. METHODS Convenience specimens from bone and joint samples submitted for culture to Children's Hospital Colorado (CHCO) from June 2012 to October 2016 were evaluated using a "Musculoskeletal Diagnostic Panel" (MDP) consisting of the Xpert MRSA/SA SSTI real-time PCR (qPCR, Cepheid) and laboratory-developed qPCRs for Kingella kingae detection and erm genes A, B, and C which confer clindamycin resistance. Results from the MDP were compared to culture and antimicrobial susceptibility testing (AST) results. RESULTS A total of 184 source specimens from 125 patients were tested. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the Xpert MRSA/SA SSTI compared to culture and AST results were 85%, 98%, 93%, and 95% respectively for MSSA and 82%, 100%, 100%, and 99% for MRSA. Compared to phenotypic clindamycin resistance in S. aureus isolates, the erm A, B, and C gene PCRs collectively demonstrated a sensitivity, specificity, PPV, and NPV of 80%, 96%, 67%, and 98%. In comparison to clinical truth, Kingella PCR had a sensitivity, specificity, PPV, and NPV of 100%, 99.5%, 100%, and 100%. CONCLUSIONS This novel MDP offers a rapid, sensitive, and specific option for pathogen detection in pediatric patients with musculoskeletal infections.
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Affiliation(s)
- Justin B Searns
- Division of Pediatric Infectious Diseases, Children's Hospital Colorado, 13123 East 16th Avenue, Aurora, CO 80045, USA
| | - Christine C Robinson
- Microbiology Department, Children's Hospital Colorado, 13123 East 16th Avenue, Aurora, CO 80045, USA
| | - Qi Wei
- Microbiology Department, Children's Hospital Colorado, 13123 East 16th Avenue, Aurora, CO 80045, USA
| | - Ji Yuan
- Microbiology Department, Children's Hospital Colorado, 13123 East 16th Avenue, Aurora, CO 80045, USA
| | - Stacey Hamilton
- Microbiology Department, Children's Hospital Colorado, 13123 East 16th Avenue, Aurora, CO 80045, USA
| | - Kristin Pretty
- Microbiology Department, Children's Hospital Colorado, 13123 East 16th Avenue, Aurora, CO 80045, USA
| | - Nathan Donaldson
- Department of Orthopedic Surgery, Children's Hospital Colorado, 13123 East 16th Avenue, Aurora, CO 80045, USA
| | - Sarah K Parker
- Division of Pediatric Infectious Diseases, Children's Hospital Colorado, 13123 East 16th Avenue, Aurora, CO 80045, USA
| | - Samuel R Dominguez
- Division of Pediatric Infectious Diseases, Children's Hospital Colorado, 13123 East 16th Avenue, Aurora, CO 80045, USA.
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Axelrad JE, Joelson A, Nobel Y, Whittier S, Lawlor G, Riddle MS, Green PHR, Lebwohl B. The Distribution of Enteric Infections Utilizing Stool Microbial Polymerase Chain Reaction Testing in Clinical Practice. Dig Dis Sci 2018; 63:1900-1909. [PMID: 29696481 DOI: 10.1007/s10620-018-5087-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Accepted: 04/20/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Gastrointestinal infection is a major cause of morbidity. We sought to characterize the pathogenic etiologies of gastrointestinal infection to identify seasonal patterns and predictors of specific infections utilizing a multiplex PCR assay in clinical practice. METHODS We performed a cross-sectional study of 9403 patients who underwent 13,231 stool tests with a FilmArray gastrointestinal pathogen PCR panel during an episode of diarrhea from March 2015 to May 2017. Our primary outcome was the presence of a positive panel. Logistic regression was used to test for associations between season and infections. RESULTS A positive result was found in 3426 tests (25.9%) in 2988 patients (31.8%), yielding 4667 pathogens consisting of 1469 viruses (31.5%), 2925 bacteria (62.7%), and 273 parasites (5.8%). Age less than 50 years was associated with a higher prevalence of pathogens compared to age ≥ 50 (p < 0.0001). The overall prevalence of a positive result for bacteria peaked in the summer (635, 29.2%), and the prevalence of viruses peaked in the winter (446, 31.8%). Compared to the winter, testing in the summer yielded a higher prevalence of bacteria (OR 1.52, 95% CI 1.33, 1.73, p < 0.0001) and lower odds of viruses (OR 0.69, 95% CI 0.58, 0.81, p < 0.0001), primarily driven by E. coli species and norovirus. CONCLUSIONS Season was a major determinant in detecting specific pathogens. Our substantially lower positivity rate than previous reports in the literature on multiplex PCR assays may more accurately reflect true clinical practice. Recognizing the temporal distribution of enteric pathogens may help facilitate empiric treatment decisions in certain clinical situations.
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Affiliation(s)
- Jordan E Axelrad
- Division of Digestive and Liver Disease, Department of Medicine, Columbia University Medical Center, 180 Fort Washington Avenue, Suite 936, New York, NY, 10032, USA
| | - Andrew Joelson
- Division of Digestive and Liver Disease, Department of Medicine, Columbia University Medical Center, 180 Fort Washington Avenue, Suite 936, New York, NY, 10032, USA
| | - Yael Nobel
- Division of Digestive and Liver Disease, Department of Medicine, Columbia University Medical Center, 180 Fort Washington Avenue, Suite 936, New York, NY, 10032, USA
| | - Susan Whittier
- Department of Microbiology, Columbia University Medical Center, New York, NY, USA
| | - Garrett Lawlor
- Division of Digestive and Liver Disease, Department of Medicine, Columbia University Medical Center, 180 Fort Washington Avenue, Suite 936, New York, NY, 10032, USA
| | - Mark S Riddle
- Department of Preventive Medicine and Biostatistics, Uniformed Services University, Bethesda, MD, USA
| | - Peter H R Green
- Division of Digestive and Liver Disease, Department of Medicine, Columbia University Medical Center, 180 Fort Washington Avenue, Suite 936, New York, NY, 10032, USA
| | - Benjamin Lebwohl
- Division of Digestive and Liver Disease, Department of Medicine, Columbia University Medical Center, 180 Fort Washington Avenue, Suite 936, New York, NY, 10032, USA.
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Calderaro A, Martinelli M, Buttrini M, Montecchini S, Covan S, Rossi S, Ferraglia F, Montagna P, Pinardi F, Larini S, Arcangeletti MC, Medici MC, Chezzi C, De Conto F. Contribution of the FilmArray ® Gastrointestinal Panel in the laboratory diagnosis of gastroenteritis in a cohort of children: a two-year prospective study. Int J Med Microbiol 2018; 308:514-521. [PMID: 29748124 DOI: 10.1016/j.ijmm.2018.04.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 04/20/2018] [Accepted: 04/30/2018] [Indexed: 02/08/2023] Open
Abstract
This study represents a 2-year picture of the epidemiology of enteric pathogens in children suffering from gastroenteritis using the FilmArray® Gastrointestinal Panel (FA-GP), a multiplex molecular assay that allows to simultaneously detect a large panel of pathogens independently of the etiological suspicion and to evaluate its potential contribution to the diagnosis compared to the conventional methods. A total of 1716 stool samples, collected from children with clinical suspicion of bacterial and/or viral gastroenteritis attending the University Hospital of Parma, was submitted to the FA-GP and, when an adequate aliquot was available, to electron microscopy (n = 1163) for virus detection and to an enterovirus-targeting real-time PCR (n = 1703). Specimens with positive results for Salmonella, Yersinia enterocolitica, Vibrio, diarrheagenic Escherichia coli/Shigella, Campylobacter, Plesiomonas shigelloides and/or parasites by the FA-GP were also submitted to conventional diagnostic methods. The FA-GP gave positive results in 958 (55.8%) cases, 64.8% from inpatients: 647 (67.5%) contained a single agent and 311 (32.5%) multiple agents, for a total of 1374 pathogens. Enteropathogenic E. coli, rotavirus, norovirus, toxigenic Clostridioides difficile, and sapovirus were the most commonly detected pathogens. A total of 812 additional agents (344 of which as single pathogen) was detected by the FA-GP and not included in the clinical suspicion. The overall recovery rate of the conventional methods from stools that resulted positive by the FA-GP was 38.6% for bacteria, 50% and 84.2% for Giardia intestinalis and Cryptosporidium, respectively, and ranged from 3.7% to 64.6% for viruses, if excluding all electron microscopy-negative astroviruses. Enterovirus, an agent not targeted by the FA-GP, was revealed in 9.6% (164/1703) of the examined samples, and in 52 cases it was the only agent detected. The results of this study allowed to extend the range of detectable pathogens independently of the clinical suspicion, to detect co-infections in almost one third of children positive for at least one agent and to show that conventional methods would have missed more than half of the enteric agents detected by the FA-GP.
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Affiliation(s)
- Adriana Calderaro
- Department of Medicine and Surgery, University of Parma, Parma, Italy.
| | - Monica Martinelli
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Mirko Buttrini
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Sara Montecchini
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Silvia Covan
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Sabina Rossi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | - Paolo Montagna
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Federica Pinardi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Sandra Larini
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | | | - Carlo Chezzi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Flora De Conto
- Department of Medicine and Surgery, University of Parma, Parma, Italy
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Clinical Impact of a Multiplex Gastrointestinal Polymerase Chain Reaction Panel in Patients With Acute Gastroenteritis. Clin Infect Dis 2018; 67:1688-1696. [DOI: 10.1093/cid/ciy357] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 04/20/2018] [Indexed: 02/06/2023] Open
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35
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Marder Mph EP, Griffin PM, Cieslak PR, Dunn J, Hurd S, Jervis R, Lathrop S, Muse A, Ryan P, Smith K, Tobin-D'Angelo M, Vugia DJ, Holt KG, Wolpert BJ, Tauxe R, Geissler AL. Preliminary Incidence and Trends of Infections with Pathogens Transmitted Commonly Through Food - Foodborne Diseases Active Surveillance Network, 10 U.S. Sites, 2006-2017. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2018; 67:324-328. [PMID: 29565841 PMCID: PMC5868202 DOI: 10.15585/mmwr.mm6711a3] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Low Yield of FilmArray GI Panel in Hospitalized Patients with Diarrhea: an Opportunity for Diagnostic Stewardship Intervention. J Clin Microbiol 2018; 56:JCM.01558-17. [PMID: 29237784 DOI: 10.1128/jcm.01558-17] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 12/06/2017] [Indexed: 12/23/2022] Open
Abstract
The FilmArray GI panel (BioFire Diagnostics, Salt Lake City, UT) is a multiplex, on-demand, sample-to-answer, real-time PCR assay for the syndromic diagnosis of infectious gastroenteritis that has become widely adopted and, in some instances, has replaced conventional stool culture and parasite exams. Conventional testing has historically been restricted among hospitalized patients due to low diagnostic yield, but it is not known whether use of the FilmArray GI panel should be circumscribed. Cary-Blair stool samples submitted for FilmArray GI panel in adult patients admitted to an academic hospital from August 2015 to January 2017 were included in this study. Of 481 tests performed >72 h after admission, 29 (6.0%) were positive, all for a single target, excluding Clostridium difficile When follow-up tests beyond the first positive per hospitalization were excluded, 20 (4.8%) of 414 tests were positive. There was no difference in yield by immune status. Most targets detected were viral (79% of all positives [n = 23] and 70% in unique patients [n = 14]). All four cases positive for a bacterial target could not be confirmed and presentation was atypical, suggesting possible false positives. After removing potential false positives and chronic viral shedders, the yield was 3.0% (12/406). Repeat testing performed >72 h after admission and following a negative result within the first 72 h was done in 19 patients and 100% (22/22) remained negative. The FilmArray GI panel has low yield in adult patients hospitalized for >72 h, similar to conventional stool microbiology tests, and it is reasonable to restrict its use in this population.
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Abstract
PURPOSE OF REVIEW Molecular-based diagnostic methods for the detection of gastrointestinal pathogens are becoming increasingly commonplace in microbiology laboratories. This review aims to summarize recent developments in this field and discuss the clinical application and limitations of implementing these techniques. RECENT FINDINGS Recent evaluations of multiplex PCR assays show increased sensitivity whenever compared with standard microbiological culture-based methods. In addition to shorter turnaround times, assays can detect an increased repertoire of pathogens from a single specimen and provide useful information for infection prevention and control practices. There are many limitations, however, associated with their use, including clinical interpretation of results and lack of concordance between different test panels. Newer technologies, such as metagenomic analysis, can provide comprehensive information useful to both patient management and public health surveillance. SUMMARY Molecular techniques are capable of replacing culture in the diagnosis of gastrointestinal infections. Whether all positive results, however, represent true infection is still debateable, as is the clinical significance of identifying more than one pathogen. As it currently stands, microbiological culture remains vital for public health surveillance, monitoring antibiotic resistance and managing outbreaks.
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A Gastrointestinal PCR Panel Improves Clinical Management and Lowers Health Care Costs. J Clin Microbiol 2017; 56:JCM.01457-17. [PMID: 29093106 DOI: 10.1128/jcm.01457-17] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 10/26/2017] [Indexed: 11/20/2022] Open
Abstract
Conventional methods for the identification of gastrointestinal pathogens are time-consuming and expensive and have limited sensitivity. The aim of this study was to determine the clinical impact of a comprehensive molecular test, the BioFire FilmArray gastrointestinal (GI) panel, which tests for many of the most common agents of infectious diarrhea in approximately 1 h. Patients with stool cultures submitted were tested on the GI panel (n = 241) and were compared with control patients (n = 594) from the year prior. The most common organisms detected by the GI panel were enteropathogenic Escherichia coli (EPEC, n = 21), norovirus (n = 21), rotavirus (n = 15), sapovirus (n = 9), and Salmonella (n = 8). Patients tested on the GI panel had an average of 0.58 other infectious stool tests compared with 3.02 in the control group (P = 0.0001). The numbers of days on antibiotic(s) per patient were 1.73 in the cases and 2.12 in the controls (P = 0.06). Patients with the GI panel had 0.18 abdomen and/or pelvic imaging studies per patient compared with 0.39 (P = 0.0002) in the controls. The average length of time from stool culture collection to discharge was 3.4 days in the GI panel group versus 3.9 days in the controls (P = 0.04). The overall health care cost could have decreased by $293.61 per patient tested. The GI panel improved patient care by rapidly identifying a broad range of pathogens which may not have otherwise been detected, reducing the need for other diagnostic tests, reducing unnecessary use of antibiotics, and leading to a reduction in hospital length of stay.
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Abbott AN, Fang FC. Clinical Impact of Multiplex Syndromic Panels in the Diagnosis of Bloodstream, Gastrointestinal, Respiratory, and Central Nervous System Infections. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.clinmicnews.2017.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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40
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Chhabra P, Gregoricus N, Weinberg GA, Halasa N, Chappell J, Hassan F, Selvarangan R, Mijatovic-Rustempasic S, Ward ML, Bowen M, Payne DC, Vinjé J. Comparison of three multiplex gastrointestinal platforms for the detection of gastroenteritis viruses. J Clin Virol 2017; 95:66-71. [PMID: 28889082 DOI: 10.1016/j.jcv.2017.08.012] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 08/22/2017] [Accepted: 08/25/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Viruses are major etiological agents of childhood gastroenteritis. In recent years, several molecular platforms for the detection of viral enteric pathogens have become available. OBJECTIVE/STUDY DESIGN We evaluated the performance of three multiplex platforms including Biofire's Gastrointestinal Panel (FilmArray), Luminex xTAG® Gastrointestinal Pathogen Panel (GPP), and the TaqMan Array Card (TAC) for the detection of five gastroenteritis viruses using a coded panel of 300 archived stool samples. RESULTS The FilmArray detected a virus in 199 (96.1%) and the TAC in 172 (83.1%) of the 207 samples (187 samples positive for a single virus and 20 samples positive for more than one virus) whereas the GPP detected a virus in 100 (78.7%) of the 127 (97 positive for one virus and three positive for more than one virus) samples. Overall the clinical accuracy was highest for the FilmArray (98%) followed by TAC (97.2%) and GPP (96.9%). The sensitivity of the FilmArray, GPP and TAC platforms was highest for rotavirus (100%, 95.8%, and 89.6%, respectively) and lowest for adenovirus type 40/41 (97.4%, 57.9% and 68.4%). The specificity of the three platforms ranged from 95.6% (rotavirus) to 99.6% (norovirus/sapovirus) for the FilmArray, 99.6% (norovirus) to 100% (rotavirus/adenovirus) for GPP, and 98.9% (astrovirus) to 100% (rotavirus/sapovirus) for TAC. CONCLUSION The FilmArray demonstrated the best analytical performance followed by TAC. In recent years, the availability of multi-enteric molecular testing platforms has increased significantly and our data highlight the strengths and weaknesses of these platforms.
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Affiliation(s)
- Preeti Chhabra
- Synergy America, Inc., Atlanta, GA, United States; Division of Viral Diseases, National Center for Immunizations and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Nicole Gregoricus
- Division of Viral Diseases, National Center for Immunizations and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Geoffrey A Weinberg
- University of Rochester School of Medicine and Dentistry, Golisano Children's Hospital, Rochester, NY, United States
| | - Natasha Halasa
- Department of Pediatrics, Vanderbilt Vaccine Research Program, Vanderbilt University Medical Center, Nashville, TN, United States
| | - James Chappell
- Department of Pediatrics, Vanderbilt Vaccine Research Program, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Ferdaus Hassan
- Department of Pathology and Laboratory Medicine, Children's Mercy Hospitals, Kansas City, MO, United States
| | - Rangaraj Selvarangan
- Department of Pathology and Laboratory Medicine, Children's Mercy Hospitals, Kansas City, MO, United States
| | - Slavica Mijatovic-Rustempasic
- Division of Viral Diseases, National Center for Immunizations and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - M Leanne Ward
- Division of Viral Diseases, National Center for Immunizations and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Michael Bowen
- Division of Viral Diseases, National Center for Immunizations and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Daniel C Payne
- Division of Viral Diseases, National Center for Immunizations and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Jan Vinjé
- Division of Viral Diseases, National Center for Immunizations and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, GA, United States.
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Saupe A, Edel B, Pfister W, Löffler B, Ehricht R, Rödel J. Acute diarrhoea due to a Shiga toxin 2e-producing Escherichia coli O8 : H19. JMM Case Rep 2017; 4:e005099. [PMID: 29026626 PMCID: PMC5630968 DOI: 10.1099/jmmcr.0.005099] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 05/23/2017] [Indexed: 12/20/2022] Open
Abstract
Introduction. Identification of non-O157 Shiga-toxin-producing Escherichia coli (STEC) infections may be underestimated in microbiological diagnosis. Case presentation. A 58-year-old woman developed diarrhoea with watery and subsequently mucous stool. Initial multiplex PCR testing revealed a positive result for stx2. Culture isolation of a STEC was successful only after repeated inoculation of chromogenic E. coli media. Molecular characterization was performed and identified the isolate as stx2e-positive STEC of serotype O8 : H19. The strain harboured lpfA, but not eae. Conclusion. This case highlights the usefulness of initial multiplex PCR for diagnosis of non-O157 STEC infection.
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Affiliation(s)
- Angela Saupe
- Institute of Medical Microbiology, Jena University Hospital, Jena, Germany
| | - Birgit Edel
- Institute of Medical Microbiology, Jena University Hospital, Jena, Germany
| | - Wolfgang Pfister
- Institute of Medical Microbiology, Jena University Hospital, Jena, Germany
| | - Bettina Löffler
- Institute of Medical Microbiology, Jena University Hospital, Jena, Germany
| | | | - Jürgen Rödel
- Institute of Medical Microbiology, Jena University Hospital, Jena, Germany
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Piralla A, Lunghi G, Ardissino G, Girello A, Premoli M, Bava E, Arghittu M, Colombo MR, Cognetto A, Bono P, Campanini G, Marone P, Baldanti F. FilmArray™ GI panel performance for the diagnosis of acute gastroenteritis or hemorragic diarrhea. BMC Microbiol 2017; 17:111. [PMID: 28494766 PMCID: PMC5427568 DOI: 10.1186/s12866-017-1018-2] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 04/28/2017] [Indexed: 12/16/2022] Open
Abstract
Background Acute gastroenteritis is a common cause of morbidity and mortality in humans worldwide. The rapid and specific identification of infectious agents is crucial for correct patient management. However, diagnosis of acute gastroenteritis is usually performed with diagnostic panels that include only a few pathogens. In the present bicentric study, the diagnostic value of FilmArray™ GI panels was assessed in unformed stool samples of patients with acute gastroenteritis and in a series of samples collected from pediatric patients with heamorragic diarrhea. The clinical performance of the FilmArray™ gastrointestinal (GI) panel was assessed in 168 stool samples collected from patients with either acute gastroenteritis or hemorragic diarrhea. Samples showing discordant results between FilmArray and routine methods were further analyzed with an additional assay. Results Overall, the FilmArray™ GI panel detected at least one potential pathogen in 92/168 (54.8%) specimens. In 66/92 (71.8%) samples, only one pathogen was detected, while in 26/92 (28.2%) multiple pathogens were detected. The most frequent pathogens were rotavirus 13.9% (22/168), Campylobacter 10.7% (18/168), Clostridium difficile 9.5% (16/168), and norovirus 8.9% (15/168). Clostridium difficile was identified only in patients with acute gastroenteritis (p < 0.01), while STEC was detected exclusively in patients with hemorragic diarrhea (p < 0.01). In addition, Campylobacter spp., Salmonella spp., EPEC and E. coli producing Shiga-like toxin were more frequently detected in patients with hemorragic diarrhea (p < 0.05). The overall percent agreement calculated in samples was 73.8% and 65.5%, while 34.5% were discordant. After additional confirmatory analyses, the proportion of discordant samples decreased to 7.7%. Rotavirus and astrovirus were the most frequently unconfirmed pathogens. Conclusion In conclusion, the FilmArray™ GI panel has proved to be a valuable new diagnostic tool for improving the diagnostic efficiency of GI pathogens.
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Affiliation(s)
- Antonio Piralla
- Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giovanna Lunghi
- Microbiology and Virology Unit, Fondazione Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gianluigi Ardissino
- Center of HUS Control, Prevention and Management, Fondazione Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessia Girello
- Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marta Premoli
- Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Erika Bava
- Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Milena Arghittu
- Microbiology and Virology Unit, Fondazione Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria Rosaria Colombo
- Microbiology and Virology Unit, Fondazione Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandra Cognetto
- Microbiology and Virology Unit, Fondazione Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Patrizia Bono
- Microbiology and Virology Unit, Fondazione Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulia Campanini
- Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Piero Marone
- Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Fausto Baldanti
- Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. .,Section of Microbiology, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.
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Is Follow-Up Testing with the FilmArray Gastrointestinal Multiplex PCR Panel Necessary? J Clin Microbiol 2017; 55:1154-1161. [PMID: 28122874 DOI: 10.1128/jcm.02354-16] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 01/19/2017] [Indexed: 12/14/2022] Open
Abstract
The FilmArray gastrointestinal (GI) panel (BioFire Diagnostics, Salt Lake City, UT) is a simple, sample-to-answer, on-demand, multiplex, nucleic acid amplification test for syndromic diagnosis of infectious gastroenteritis. The aim of this study was to measure the yield of follow-up testing with FilmArray GI panel within 4 weeks of an initial test. Consecutive adult and pediatric patients tested at an academic institution between August 2015 and June 2016 were included in this study. Of 145 follow-up tests in 106 unique patients with an initial negative result, 134 (92.4%) tests and 98 (92.5%) patients remained negative upon follow-up testing. Excluding targets that are not reported at this institution (Clostridium difficile, enteroaggregative Escherichia coli, enteropathogenic E. coli, and enterotoxigenic E. coli), 137 (94.5%) follow-up tests and 101 (95.3%) patients remained negative. Weekly conversion rates were not significantly different across the 4-week follow-up interval. No epidemiological or clinical factors were significantly associated with a negative to positive conversion. Of 80 follow-up tests in patients with an initial positive result, 43 (53.8%) remained positive for the same target, 34 (42.5%) were negative, and 3 were positive for a different target (3.8%). Follow-up testing with FilmArray GI panel within 4 weeks of a negative result rarely changed the initial result, and the follow-up test reverted to negative less than half the time after an initial positive result. In the absence of clinical or epidemiological evidence for a new infection, follow-up testing should be limited and FilmArray GI panel should not be used as a test of cure.
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