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Observational Study
. 2018 Apr 25;56(5):e00148-18.
doi: 10.1128/JCM.00148-18. Print 2018 May.

Rapid Molecular Detection of Gastrointestinal Pathogens and Its Role in Antimicrobial Stewardship

Şiran Keske  1 , Burak Zabun  2 , Kahraman Aksoy  2 , Füsun Can  3 , Erhan Palaoğlu  4 , Önder Ergönül  5
Affiliations
Observational Study

Rapid Molecular Detection of Gastrointestinal Pathogens and Its Role in Antimicrobial Stewardship

Şiran Keske et al. J Clin Microbiol. .

Abstract

We aimed to detect the etiological agents of acute diarrhea by a molecular gastrointestinal pathogen test (MGPT) and to assess the impact of MGPT on antimicrobial stewardship programs (ASP). This is a prospective observational study and was conducted between 1 January 2015 and 30 June 2017. We included consequent patients who had acute diarrhea. At the end of 2015, we implemented ASP in acute diarrhea cases and compared the outcomes in the pre-ASP and post-ASP periods. An FDA-cleared multiplexed gastrointestinal PCR panel system, the BioFire FilmArray (Idaho Technology, Salt Lake City, UT), which detects 20 pathogens in stool, was used. In 499 out of 699 patients (71%), at least one pathogen was detected. Among 314 adults with positive MGPT, 101 (32%) enteropathogenic Escherichia coli (EPEC), 71 (23%) enteroaggregative E. coli (EAEC), 68 (22%) enterotoxigenic E. coli (ETEC), 55 (18%) Shiga toxin-producing E. coli (STEC) (17%) Norovirus, 48 (15%) Campylobacter, 21 (7%) Salmonella, and 20 (6%) Clostridium difficile strains were detected. Among 185 children, 55 (30%) EPEC, 37 (20%) C. difficile, 32 (17%) Norovirus, 29 (16%) EAEC, 22 (12%) STEC, 21 (11%) ETEC, 21 (11%) Campylobacter, 20 (11%) Salmonella, and 16 (5%) Rotavirus strains were detected. Inappropriate antibiotic use decreased in the post-ASP period compared with the pre-ASP period among inpatients (42.9% and 25.8%, respectively; P = 0.023). Using MGPT in clinical practice significantly decreased the unnecessary use of antibiotics. Detection of high rates of C. difficile in children and Salmonella spp., as well as relatively high rates of Campylobacter spp., which were hard to isolate by routine stool culture, were remarkable.

Keywords: antimicrobial stewardship; diarrhea; gastroenteritis; molecular test; multiplex.

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Figures

FIG 1
FIG 1
Study population.
FIG 2
FIG 2
The most commonly detected pathogens among the patients with acute gastroenteritis. y axis represents number of each pathogen detected.
See this image and copyright information in PMC

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