Appropriateness of a Rapid Multiplex Gastrointestinal Panel in the Investigation of Suspected Infectious Diarrhea After Implementation at an Academic Medical Center

Abstract

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.

Variation in stool testing for children with acute gastrointestinal infections

“…however, at least one independent study reported doubling of costs compared to conventional methods and another study reported low conformity with institutional testing guidelines following local implementation of a real-time PCR test. 43,44 Other studies demonstrate that use of PCR tests can result in increased identification of C. difficile and other potential pathogens (e.g., Salmonella) in young children and healthy controls, potentially contributing to unnecessary treatment. 10,20,45,46 outcomes.…”

“…While multiplex gastrointestinal PCR studies offer improved sensitivity, decreased time to results, and improved time to initiation of antimicrobials, Cotter et al previously demonstrated a 21% overall increase in stool testing following their implementation with improvement in outcomes in only 3% of tested patients 19 . Some adult‐focused studies demonstrate that use of multiplex PCRs can contribute to reductions in healthcare expenditures including reductions in associated resources including endoscopy, diagnostic imaging, and antimicrobial use 17,42 ; however, at least one independent study reported doubling of costs compared to conventional methods and another study reported low conformity with institutional testing guidelines following local implementation of a real‐time PCR test 43,44 . Other studies demonstrate that use of PCR tests can result in increased identification of C. difficile and other potential pathogens (e.g., Salmonella ) in young children and healthy controls, potentially contributing to unnecessary treatment 10,20,45,46 .…”