Comparison of the BD MAX Enteric Bacterial Panel to Routine Culture Methods for Detection of Campylobacter, Enterohemorrhagic Escherichia coli (O157), Salmonella, and Shigella Isolates in Preserved Stool Specimens

Anderson, Neil W.; Buchan, Blake W.; Ledeboer, Nathan A.

doi:10.1128/jcm.03099-13

Cited by 55 publications

(24 citation statements)

References 12 publications

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“…Therefore, it is unclear whether the discrepant culture results were due to the higher than expected prevalence of EIEC or to the rather poor sensitivity for Shigella cultures, as has been reported by several authors (7,9,(12)(13)(14). Difficulties with culturing Shigella were also illustrated in a case in our study.…”

Section: Discussionmentioning

confidence: 53%

Evaluation of a Multiplex Real-Time PCR Assay for Detecting Major Bacterial Enteric Pathogens in Fecal Specimens: Intestinal Inflammation and Bacterial Load Are Correlated in Campylobacter Infections

et al. 2016

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. Significant differences were observed among the three groups (P < 0.001), and a significant linear trend was identified (P < 0.001). Furthermore, the fecal calprotectin concentrations and C T values were found to be correlated (r ‫؍‬ ؊0.658). Our results demonstrate that molecular screening of Campylobacter spp., Salmonella spp., and Shigella spp./EIEC using the BD Max EBP assay will result in timely diagnosis and improved sensitivity. The determination of inflammatory markers, such as calprotectin, in fecal specimens may aid in the interpretation of PCR results, particularly for enteric pathogens associated with mucosal damage and colonic inflammation.A cute bacterial gastroenteritis is a common global health problem. Infections with Salmonella spp., Campylobacter spp., and Shiga toxin-producing Escherichia coli (STEC) are spread to humans from animal reservoirs. In contrast, humans are the primary reservoir of Shigella spp. These four microorganisms are the most commonly reported enteric bacterial pathogens responsible for community-acquired diarrhea (1, 2). Conventional bacterial stool culturing is considered the traditional gold standard for diagnosis of the most common bacterial pathogens (3, 4), and current guidelines recommend one to two culture specimens for adult patients and one specimen for pediatric patients (5). Fresh stool specimens should be transported to the laboratory and processed within 2 h of collection (6, 7). If the specimen cannot be processed within 2 h, it should be placed in a transport medium to preserve the viability of bacterial pathogens, particularly Shigella and Campylobacter. Antibiotics administered at the time of specimen collection may compromise the outcome of stool culturing (8).Several novel molecular assays for detecting enteric bacterial pathogens in stool specimens have been developed. These assays are very specific, and their sensitivities are superior to those of conventional methods (3,7,9,10). Among these tests, the BD Max enteric bacterial panel (EBP) is an FDA-cleared, multiplex PCR assay designed for the detection of Salmonella spp., Shigella spp./enteroinvasive E. coli (EIEC), Campylobacter spp. (Campylobacter jejuni and Campylobacter coli), and Shiga-like toxin genes (stx 1 and/or stx 2 ) in preserved and unpreserved stool specimens using the BD Max system (BD Diagnostics, Allschwil, Switzerland). The BD Max system is a walkaway PCR instrument that can extract, amplify, and detect nucleic acids in batches of up to 24 samples within 3 h, requiring less than 2 min of hands-on time per sample (11).In this study, we aimed to achieve the following: (i) to evaluate the performance of molecular testing compared with that of conventional culture methods in a privately owned clinical microbiology laboratory, currently serving approximately 2,200 hospital beds and several hundred physicians in private practice; (ii) to study the association between the relative bacterial load, as assessed using the threshold cycle (C T ) values of pathogen-specific PCR targets, and the...

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Section: Discussionmentioning

confidence: 53%

Evaluation of a Multiplex Real-Time PCR Assay for Detecting Major Bacterial Enteric Pathogens in Fecal Specimens: Intestinal Inflammation and Bacterial Load Are Correlated in Campylobacter Infections

et al. 2016

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“…Our study also provides real-world data in which informed considerations can be made on whether and how Campylobacter case definitions should be modified in the future. Highly sensitive and more specific nucleic acid amplification assays have more recently been approved by the FDA and may be preferable to stool antigen assays as alternatives to culture for detecting Campylobacter in stool (23)(24)(25)(26).…”

Section: Discussionmentioning

confidence: 99%

Multicenter Evaluation of Clinical Diagnostic Methods for Detection and Isolation of Campylobacter spp. from Stool

et al. 2016

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The use of culture-independent diagnostic tests (CIDTs), such as stool antigen tests, as standalone tests for the detection of Campylobacter in stool is increasing. We conducted a prospective, multicenter study to evaluate the performance of stool antigen CIDTs compared to culture and PCR for Campylobacter detection. Between July and October 2010, we tested 2,767 stool specimens from patients with gastrointestinal illness with the following methods: four types of Campylobacter selective media, four commercial stool antigen assays, and a commercial PCR assay. Illnesses from which specimens were positive by one or more culture media or at least one CIDT and PCR were designated "cases." A total of 95 specimens (3.4%) met the case definition. The stool antigen CIDTs ranged from 79.6% to 87.6% in sensitivity, 95.9 to 99.5% in specificity, and 41.3 to 84.3% in positive predictive value. Culture alone detected 80/89 (89.9% sensitivity) Campylobacter jejuni/Campylobacter coli-positive cases. Of the 209 noncases that were positive by at least one CIDT, only one (0.48%) was positive by all four stool antigen tests, and 73% were positive by just one stool antigen test. The questionable relevance of unconfirmed positive stool antigen CIDT results was supported by the finding that noncases were less likely than cases to have gastrointestinal symptoms. Thus, while the tests were convenient to use, the sensitivity, specificity, and positive predictive value of Campylobacter stool antigen tests were highly variable. Given the relatively low incidence of Campylobacter disease and the generally poor diagnostic test characteristics, this study calls into question the use of commercially available stool antigen CIDTs as standalone tests for direct detection of Campylobacter in stool. Campylobacter infection continues to be a major public health problem. Campylobacter jejuni and Campylobacter coli are pathogens transmitted commonly through food, causing an estimated 1.3 million cases of illness per year in the United States (1), and yet diagnosis can be challenging because the organism is difficult to isolate, grow, and identify. Recent reports describing clinical laboratory practices for Campylobacter diagnostics in Pennsylvania (2) and the Foodborne Diseases Active Surveillance Network (FoodNet) sites (3) highlight the wide range of testing practices in use; currently, no best-practice clinical or public health laboratory guidelines exist for laboratory diagnosis of Campylobacter infections. Direct plating onto a Campylobacter selective medium, followed by incubation at 42°C under microaerobic conditions for 72 h, has long been considered the "gold standard" for diagnosis (4).The use of culture-independent diagnostic tests (CIDTs) for Campylobacter testing on stool samples is increasing, which may have important implications for both patient management and public health surveillance efforts (5). Stool antigen tests to directly detect Campylobacter in fecal samples are fast and generate sameday results, but concerns regarding speci...

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“…These include the bioMerieux Biofire Filmarray system, 46 BD MAX system, 47 Luminex xTAG system, 48, 49 Savyon Diagnostics system, 48 and Genetic Signatures system. 50 These panels allow rapid identification of Salmonella, Shigella , and Yersinia from primary stool specimens, and offer substantially improved turnaround time on primary laboratory diagnosis compared with culture-based methods.…”

Section: Introductionmentioning

confidence: 99%

Salmonella, Shigella, and Yersinia

Dekker

Frank

2015

Clinics in Laboratory Medicine

121

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Synopsis Salmonella, Shigella, and Yersinia cause a well-characterized spectrum of disease in humans, ranging from asymptomatic carriage to hemorrhagic colitis and fatal typhoidal fever. These pathogens are responsible for millions of cases of food-borne illness in the U.S. each year, with substantial costs measured in hospitalizations and lost productivity. In the developing world, illness caused by these pathogens is not only more prevalent, but is also associated with a greater case-fatality rate. Classical methods for identification rely on selective media and serology, but newer methods based on mass spectrometry and PCR show great promise for routine clinical testing.

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Comparison of the BD MAX Enteric Bacterial Panel to Routine Culture Methods for Detection of Campylobacter, Enterohemorrhagic Escherichia coli (O157), Salmonella, and Shigella Isolates in Preserved Stool Specimens

Cited by 55 publications

References 12 publications

Evaluation of a Multiplex Real-Time PCR Assay for Detecting Major Bacterial Enteric Pathogens in Fecal Specimens: Intestinal Inflammation and Bacterial Load Are Correlated in Campylobacter Infections

Evaluation of a Multiplex Real-Time PCR Assay for Detecting Major Bacterial Enteric Pathogens in Fecal Specimens: Intestinal Inflammation and Bacterial Load Are Correlated in Campylobacter Infections

Multicenter Evaluation of Clinical Diagnostic Methods for Detection and Isolation of Campylobacter spp. from Stool

Salmonella, Shigella, and Yersinia

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