Comparison of Multiplex Gastrointestinal Pathogen Panel and Conventional Stool Testing for Evaluation of Patients With HIV Infection

Sobczyk, J; Jain, Sonia; Sun, Xiaoying; Karris, Maile Y.; Wooten, Darcy; Stagnaro, Janet; Reed, Sharon L.

doi:10.1093/ofid/ofz547

Cited by 10 publications

(18 citation statements)

References 29 publications

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“…In this study, the overall rate of enteric infection by GI panel was 46%, similar to a previous study in PLWH with diarrhea (53%), and higher than previous studies of diarrhea in the general population (35–37%). 17 , 18 Despite higher rates of enteric infection in PLWH, we found no differences in overall enteric infection rates by CD4 count within the PLWH population. In patients with a low CD4 count, however, there were fewer bacterial enteric infections.…”

Section: Discussioncontrasting

confidence: 56%

“…The most common pathogen overall was EPEC, which is known to be common in PLWH with diarrheal illness and was the most commonly detected organism in a multinational study of community acquired gastroenteritis. 17 , 24 Norovirus, a common viral pathogen in PLWH with diarrhea, was the most common viral pathogen identified by GI panel in our study. 25 , 26 …”

Section: Discussionmentioning

confidence: 60%

“…The GI panel has advantages over traditional stool immunoassay testing in PLWH, including faster test turnaround time and improvement in antibiotic stewardship via detection of viral enteric infections not identified on conventional stool testing. 17 As the GI panel is increasingly used over conventional stool testing in this population, it is critical to understand factors that may affect the interpretability of its results.…”

Section: Discussionmentioning

confidence: 99%

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The influence of hospitalization and HIV severity on gastrointestinal PCR panel evaluation of HIV-related acute diarrhea in New York City: a retrospective, cross-sectional study

Verma

Hine

Joelson

et al. 2022

Therap Adv Gastroenterol

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Introduction: Diarrhea is common in persons living with HIV (PLWH)/AIDS. With the increasing utilization of multiplex gastrointestinal PCR panel (GI panel) testing, we aimed to characterize the roles of CD4 count and hospitalization in GI panel assessments of PLWH with acute diarrhea. Methods: We performed a cross-sectional study of adult PLWH with acute diarrhea who underwent GI panel testing at two urban academic centers. Demographic, HIV disease, GI panel result, and hospitalization data were collected, and patients were cohorted by CD4 count (CD4 < 200, CD4 200–499, CD4 > = 500). The primary outcome was enteric infection as detected by GI panel, and hospitalization. Results: Of 298 PLWH, 119 (39.9%) had a CD4 count below 200, 195 (65.4%) were hospitalized, and 137 (46.0%) had enteric infection. Bacterial infection correlated with higher CD4 count (41.9% (CD4 > = 500) vs 31.2% (CD4 200–499) vs 25.2% (CD4 < 200), p = 0.041). Hospitalization correlated with poorly controlled HIV and fewer enteric infections (34.4% vs 68.0%, p < 0.001). After adjusting for HIV disease severity, a negative GI panel remained independently associated with hospitalization (adjusted odds ratio (aOR) 5.32, 95% confidence interval (CI) 2.72–10.9), even in patients tested within 72 hours of hospitalization. Despite better HIV control, men who have sex with men (MSM) had more frequent infectious diarrhea, including from E. coli, giardiasis, and multiple pathogens. MSM status independently predicted enteric infection (aOR 1.93, 95% CI: 1.02–3.67). Conclusions: GI panel results vary by HIV disease severity and hospitalization in PLWH. Clinicians – especially in the inpatient setting – should carefully consider these factors when interpreting GI panel results. Further characterization of diarrheal etiology in PLWH with a negative GI panel is needed. Plain Language Summary PCR stool test results are affected by certain factors in HIV-related diarrhea Diarrhea is common in people living with HIV (PLWH) and has a variety of causes, including infections, medications, and HIV itself. Multiplex polymerase chain reaction (PCR) stool testing simultaneously evaluates for a variety of common viral, bacterial, and parasitic infections of the gastrointestinal tract, and is increasingly being used in patients with diarrhea. However, patients with HIV and diarrheal illness may have uncommon infections not typically present in those with normal immune function – and thus not routinely evaluated for in stool testing. It is not known what factors, if any, might affect the results of PCR testing in HIV-related diarrhea. In this study, we examined all PLWH who underwent stool PCR testing for diarrhea over a 4-year period. We separated the patients into groups based on HIV disease severity as measured by CD4 T-cell count, or the count of the immune cells affected by HIV. We examined whether there were differences among groups in infection rates as detected by PCR stool testing. Separately, we studied the role of hospitalization in stool PCR test results. Of 298 PLWH who underwent stool PCR testing for diarrhea, 119 had a CD4 count less than 200 (low CD4 count), 195 were hospitalized at time of testing, and 137 had a positive stool PCR test. Compared to those with a low CD4 count, subjects with less severe HIV disease were more likely to have a bacterial infection on stool PCR testing and less likely to be hospitalized. Hospitalized patients were more likely to have a negative PCR stool test, regardless of CD4 count. Many patients with a low CD4 count had diarrheal etiologies not evaluated by multiplex stool PCR. In PLWH who experience diarrhea, stool PCR testing results vary by CD4 count and hospitalization. Providers should be mindful of these factors when interpreting stool PCR test results.

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Section: Discussioncontrasting

confidence: 56%

Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 99%

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The influence of hospitalization and HIV severity on gastrointestinal PCR panel evaluation of HIV-related acute diarrhea in New York City: a retrospective, cross-sectional study

Verma

Hine

Joelson

et al. 2022

Therap Adv Gastroenterol

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“…Shu-Huan Huang et al found in their study co-infections in 10.6% of cases [10]. A study conducted in California focusing on patients with HIV infection revealed co-infections in 48.4% of patients [11].…”

Section: Discussionmentioning

confidence: 99%

Stool culture versus FilmArray gastrointestinal PCR in the diagnosis of gastrointestinal infections

Baiya¹,

Hanchi²,

Soraa³

2022

GSC Adv. Res. Rev.

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Introduction: Gastrointestinal infection is a major cause of morbidity worldwide. Culture and microscopy are time consuming and have low diagnostic yield. New rapid molecular methods such as multiplex PCR have recently been introduced for etiological diagnosis. The purpose of this study was to compare the diagnostic yield of the FilmArray gastrointestinal panel with that of standard culture for the etiological diagnosis of gastrointestinal infections. Materials and methods: This is a retrospective study carried out within the Microbiology department of the Arrazi hospital of the CHU Mohamed VI, including all the patients treated for a gastrointestinal infection and having required hospitalization in the various departments within the Arrazi Hospital of the CHU Mohamed VI in Marrakech, over a period of 15 months. Results: During the period studied, 124 patients were sampled. All samples were tested using stool culture and FilmArray. PCR detected significantly more positive samples, with bacterial, viral and/or parasitic infections compared to stool culture (57.3% vs 21%). Additionally, gastrointestinal PCR was able to detect all pathogens implicated in the gastrointestinal FilmArray panel except for Yersinia Enterocolitica, whereas stool culture could only detect three bacterial pathogens (E.coli, Salmonella and Shigella). Additionally, 52.11% of patients had co-infections that were identified only by PCR. Conclusions: The FilmArray GI panel showed very good diagnostic performance compared to culture for the diagnosis of gastrointestinal infections and gave a more detailed picture of the spectrum of pathogens involved. Further studies are needed to determine whether multiplex PCR improves patient outcomes and reduces costs.

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“…This time is longer when compared to the study of Mortensen et al (2015) where the culture results only require 1.7-2.25 days. In another study in California, it was mentioned that the time needed for fecal culture was 2.97 days (Sobczyk et al, 2020).…”

Section: • Specimen Examination Timementioning

confidence: 99%

Microbial Patterns of Hospitalized Hiv Positive Patients Admitted in Dr. Soetomo General Hospital, Surabaya Indonesia

2021

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Background: HIV patients with a weak immune system are very vulnerable to opportunistic infections, can trigger systemic endothelial activation and end up as a condition of sepsis. In Indonesia currently, there is no bacterial epidemiological mapping of the etiology of opportunistic infections in HIV patients. Purpose: To determine the pattern of bacteria that cause opportunistic infections and their antibiotic sensitivity in HIV patients. Method: Prospective observational study design. Data were obtained from medical records of hospitalized patients at RSUD Dr. Soetomo Surabaya from August 2019 - February 2020. Result: Out of 64 patients, 83 specimens were found with the most types of gram-negative bacteria 44.6%, while gram-positive bacteria were 15.7% and a mix of 2.4% and 37.3% negative culture. The highest prevalence of gram-negative bacteria was Klebsiella pneumoniae (35.15), followed by Escherichia coli (10.8%), Pseudomonas aeruginosa (8.1%), and Acinetobacter baumanii (8.1%). The highest prevalence of gram-positive bacteria was Streptococcus mitis / oralis (30.7%), followed by Staphylococcus aureus (23.1%) and Staphylococcus epidermidis (15.4%). Among gram-negative bacteria antibiotic, Cefoperazone-sulbactam showed the greatest sensitivity, following by Amikacin, Gentamycin and Piperacillin-tazobactam; while among gram-positive bacteria are Chloramphenicol, Linezolid, and Vancomycin. Almost all isolates showed resistance to Ampicillin. Conclusion: Bacteria pattern that caused opportunistic infection in RSUD Dr. Soetomo is K. pneumonia as most common gram-negative bacteria followed by E. coli, P. aeruginosa and A. baumanii; while the most gram-positive bacteria found are S. mitis/oralis and S. aureus. Among antibiotic used, Ampicillin showed the lowest sensitivity to almost all bacteria isolates.

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Comparison of Multiplex Gastrointestinal Pathogen Panel and Conventional Stool Testing for Evaluation of Patients With HIV Infection

Cited by 10 publications

References 29 publications

The influence of hospitalization and HIV severity on gastrointestinal PCR panel evaluation of HIV-related acute diarrhea in New York City: a retrospective, cross-sectional study

The influence of hospitalization and HIV severity on gastrointestinal PCR panel evaluation of HIV-related acute diarrhea in New York City: a retrospective, cross-sectional study

Stool culture versus FilmArray gastrointestinal PCR in the diagnosis of gastrointestinal infections

Microbial Patterns of Hospitalized Hiv Positive Patients Admitted in Dr. Soetomo General Hospital, Surabaya Indonesia

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