BackgroundThe BioFire FilmArray™ Gastrointestinal (GI) Panel is a 1 hour multiplex real-time PCR test that can detect the presence of 22 GI pathogens (viral, bacterial, and parasitic) known to cause infectious diarrhea. Our tertiary-care academic medical center implemented the GI Panel for all cases of suspected infectious diarrhea replacing the previous conventional testing once utilized to detect GI pathogens. Since its implementation we have not had any criteria for ordering this test to aid healthcare providers.MethodsThe aim of this IRB approved, retrospective investigation was to determine the appropriateness of ordering the GI panel at our academic institution. Cases were randomly selected, stratified by age group and result (specific pathogens or negative result) from May 2015 through April 2016 in the post-implementation period (n = 400 of 1117 total tests). We developed appropriateness criteria for ordering the GI panel which included: passage of at least 3 unformed stools in 24 hours plus one or more enteric symptom (nausea, vomiting, abdominal pain/cramps, tenesmus, fecal urgency, moderate to severe flatulence), and one of the following: grossly bloody diarrhea (dysenteric), persistent diarrhea (14 – 30 days), worsening or relapsing diarrhea, fever ≥ 101 F°, severe diarrhea > 10 bouts in 24hrs, immunosuppression, pregnancy, food handler, infant < 1 year and their care takers, age ≥ 65 years old, concern for disseminated GI infection, with no previous GI panel testing in the past 30 days.ResultsOverall appropriateness of GI panel testing based off our generated criteria was 36% (n = 144/400). This included all tests ordered in the outpatient clinics, emergency department, inpatient medical/surgical wards, and intensive care units.ConclusionCurrently there is not a well-established standard criteria for ordering the GI panel for investigating suspected infectious diarrhea. After implementation at our academic tertiary-care medical center the GI panel was used inappropriately in most cases without a criteria for ordering in place to aid clinicians. Educating healthcare providers about appropriate testing indications is being performed. Further studies are needed to assess if our generated criteria will lead to decreased costs and unnecessary testing.Disclosures
All authors: No reported disclosures.
BackgroundThe BioFire FilmArray™ Gastrointestinal (GI) Panel is a 1 hour multiplex real-time PCR test that can detect the presence of 22 GI pathogens (viral, bacterial, and parasitic) known to cause infectious diarrhea. Our tertiary-care academic medical center implemented the GI Panel for all cases of suspected infectious diarrhea replacing the previous conventional testing once utilized to detect GI pathogens.MethodsThe aim of this IRB approved, retrospective investigation was to determine the utility of the GI panel testing vs. the conventional testing to guide patient management. Cases were randomly selected, stratified by age group and result (specific pathogens or negative result) in the pre-implementation period (n = 119 of 1550 samples) from May 2014 through April 2015 and in the post-implementation period (n = 333 of 1117 samples) from May 2015 through April 2016.ResultsThe rate of a positive test for any stool pathogen per patient was 34.2% (n = 342 of 999) for the GI panel and 11.6% (n = 162 of 1391) for conventional testing, P = <0.0001. Median time to test result from collection was 3.3 hours for the GI panel vs 45.4 hours for culture (P < 0.0001). Among patients started on antibiotics prior to result, discontinuation rate was 33% (n = 30/90) after GI panel results vs 5.4% (n = 2/37) after stool culture results, P = 0.0014. Antibiotics were initiated or adjusted after the result in 28.5% of patients (95/333) in the GI panel cohort compared with 60.5% (72/119) in the culture cohort; however, this was influenced by the method for selecting cases and the higher yield of viral pathogens in the GI Panel cohort. Mean time to antibiotic adjustment was 2.1 hours with the GI panel vs 22.0 hours in the culture cohort (P = 0.0155). Appropriateness of antibiotic use, adjudicated after the test result became available was significantly higher in the GI panel group (91%), compared with the culture group (81%), P < 0.0039.ConclusionAfter implementation of a rapid multiplex GI pathogen panel to evaluate stool samples from patients with suspected infectious diarrhea, our institution saw benefits in antibiotic stewardship, including: higher diagnostic yield, faster results, higher rates of antibiotic discontinuation, shorter time to antibiotic adjustment and a lower rate of inappropriate antibiotic treatment.Disclosures
All authors: No reported disclosures.
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