Clinical Yield of a Molecular Diagnostic Panel for Enteric Pathogens in Adult Outpatients With Diarrhea and Validation of Guidelines-Based Criteria for Testing

Clark, Stephen; Sidlak, Michael; Mathers, Amy J; Poulter, Melinda D.; Platts-Mills, James A

doi:10.1093/ofid/ofz162

Cited by 14 publications

(5 citation statements)

References 23 publications

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“…This study shows that the Novodiag Bacterial GEϩ kit has excellent analytical performance to detect bacterial enteropathogens in stools. This new kit showed better sensitivity than culture in accordance with the literature on syndromic molecular diagnosis (15)(16)(17)(18)(19)(20)(21)(22)(23)(24). This gain of sensitivity allowed the detection of 2 Shigella sp./EIEC and 2 C. jejuni from patients with negative culture but suggestive symptoms.…”

Section: Discussionsupporting

confidence: 72%

Performance Evaluation of the Novodiag Bacterial GE+ Multiplex PCR Assay

Roy

Damien²,

Bénéjat

et al. 2020

J Clin Microbiol

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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. 251 stools were included in this study (198 retrospective and 53 prospective). The analytical performance was calculated using a composite reference standard (CRS) in 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 RT-PCRs 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/EIEC, Yersinia enterocolitica, EHEC and ETEC ranged from 98.98 to 100%, and specificities from 98.08 to 100%, PPV from 88.24 to 100% and NVP 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 Campylobacters is very satisfactory.

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Section: Discussionsupporting

confidence: 72%

Performance Evaluation of the Novodiag Bacterial GE+ Multiplex PCR Assay

Roy

Damien²,

Bénéjat

et al. 2020

J Clin Microbiol

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“…Our findings are consistent with those of a previous report of outpatients with diarrhea, where over 30% of orders for comprehensive testing did not meet the testing criteria established in the 2017 IDSA guidelines, 10 and over 20% of immunocompetent patients received antibiotics for pathogens that did not merit therapy. 8 …”

Section: Discussionmentioning

confidence: 99%

“…4 Comprehensive gastrointestinal (GI) PCR testing has been associated with decreased imaging, endoscopy, and antibiotic use, [5][6][7] but the optimal use of this assay remains unclear in the outpatient setting. 8 Patients may be tested for CDI with specific or comprehensive assays, but there is no guidance for which test to use and how to consider the pretest probability of alternate enteropathogens. To inform future interventions aimed at optimizing the use of these assays, we described their use among immunocompetent patients with and without CDI risk factors across different outpatient and nonmedically acute inpatient settings.…”

Section: Introductionmentioning

confidence: 99%

Evaluating outpatient diagnostic stewardship of comprehensive polymerase chain reaction Clostridioides difficile testing in a regional health system

Golovaty,

Tulloch-Palomino

2023

ASHE

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Objective: We examined the use of comprehensive and targeted polymerase chain reaction (PCR) of Clostridioides difficile infection (CDI) among immunocompetent patients with and without CDI risk factors across different outpatient settings. A priori, we expected patients with higher CDI risk to be associated with targeted testing to reflect providers incorporating pretest risk factors in their choice of test assay. Design: Retrospective analysis of adult patients from clinic, emergency room, and non-medically acute inpatient settings. Setting: A tertiary academic medical center offering inpatient and outpatient medical, surgical, mental health, and rehabilitation services to Veterans across the Puget Sound region. Patients: Immunocompetent adult patients with ≥1 stool PCR assay performed between January 2016 and December 2019. Intervention: Patients were tested with either a specific tcdB PCR assay or a comprehensive gastrointestinal PCR panel that tests for 22 pathogens. Results: A total of 2,717 tests (74% targeted, 26% comprehensive) were obtained from 2,156 patients, among which 13% detected C. difficile and 7% detected other organisms. The proportion of comprehensive PCR tests increased nearly four-fold from 2016 to 2019 in clinic and emergency room settings, independent of CDI risk factors. Only two CDI risk factors (prior history of CDI and antibiotic use within three months before testing) were associated with increased targeted testing. Conclusion: The use of comprehensive GI PCR among immunocompetent adults with diarrhea is increasing in the outpatient setting. There may be an opportunity for diagnostic stewardship by nudging providers to consider all CDI risk factors at the time of test selection.

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“…Further investigation into the underlying mechanisms revealed that psychological factors prior to infection and the severity of TD symptoms (rather than immunological or gene expression differences) were associated with the development of PI-AC. Additional research is necessary to better understand the role of TD in the development of PIIBS and other PI-AC, as well as to explore potential interventions to mitigate these effects [82].…”

Section: Post-infectious Chronic Gastrointestinal Disordersmentioning

confidence: 99%

Recent Advances in Travelers’ Diarrhea: Epidemiology, Diagnosis, and Treatment

Atluri,

Raghukumar,

Sreenath

2024

Prensa Med Argent

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and the Middle East being at the greatest risk [5]. The precise epidemiology of TD is not well comprehended. The incidence is higher in individuals visiting countries with limited resources, but the specific rates vary depending on the location and time of year of travel [6]. The cause of diarrhea is determined by the geographical area, food hygiene standards, sanitation practices, water supply, and the season. In more than half of individuals with diarrhea, no specific pathogens are identified. When it comes to returning travelers, approximately 50% of cases are caused by bacteria such as enterotoxigenic Escherichia coli, Salmonella, Shigella, Campylobacter, Vibrio, Yersinia, and Aeromonas [7]. MethodsComparing certain reports published between 2000 and 2018 containing the terms 'traveler's diarrhea' (including variations such as travelers and diarrhoea

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Clinical Yield of a Molecular Diagnostic Panel for Enteric Pathogens in Adult Outpatients With Diarrhea and Validation of Guidelines-Based Criteria for Testing

Cited by 14 publications

References 23 publications

Performance Evaluation of the Novodiag Bacterial GE+ Multiplex PCR Assay

Performance Evaluation of the Novodiag Bacterial GE+ Multiplex PCR Assay

Evaluating outpatient diagnostic stewardship of comprehensive polymerase chain reaction Clostridioides difficile testing in a regional health system

Recent Advances in Travelers’ Diarrhea: Epidemiology, Diagnosis, and Treatment

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