Work

Impact of a Stool Multiplex Polymerase Chain Reaction Rapid Diagnostic Test on Antibiotic Prescribing in Patients Hospitalized With Diarrhea of Suspected Infectious Etiology

Year: 2016

Type: article

Abstract: Background. Rapid diagnostic tests are being increasingly used in clinical practice, but their impact on clinical care has not been adequately described. In December 2014, the FilmArray Gastrointestinal (GI) Panel (stool polymerase chain reaction [PCR]) was implemented at Denver Health. This panel tests for 22 common pathogens including bacteria, viruses, and parasites. The purpose of this study is to evaluate the diagnostic yield of the stool PCR and its effect on antimicrobial management in patients hospitalized with diarrhea of suspected infectious etiology. Methods. This is a retrospective cohort study. All inpatients who had stool PCR ordered between December 2014 and February 2016 were identified from our hospital data warehouse. We performed manual chart review of each case where the stool PCR detected a pathogen to determine clinical management. The primary outcome of interest was the frequency of initiation, change, or discontinuation of antimicrobial therapy based on the stool PCR result. Results. Stool PCR was ordered 433 times on 291 unique inpatients. Of the tests ordered, 221 (51%) were performed. In the majority of cases where the test was not performed, a specimen was not received by laboratory. Of the 221 stool PCR tests performed, a pathogen was detected in 94 (43%). The most common pathogens were Clostridium difficile (51, 54%), norovirus (14, 15%), and enteropathogenic Escherichia coli (13, 14%). In the 94 cases where a pathogen was identified, clinical management was changed in 73 (78%) patients, including the initiation or modification of antibiotics in 47 (50%) patients and the discontinuation of antibiotic therapy in 26 (28%) patients. Of the 47 patients who had antibiotics initiated or modified, 30 (32%) patients had a pathogen other than C difficile detected by stool PCR. Conclusion. In hospitalized patients, the use of a multiplex stool PCR diagnostic test led to a change in antibiotic prescribing in 17% of cases in which it was ordered and 78% of cases in which a pathogen was identified. Additional analysis to evaluate appropriateness of antimicrobial prescribing based on stool PCR results is underway. Disclosures. All authors: No reported disclosures.

Source: Open Forum Infectious Diseases

DOI: 10.1093/ofid/ofw172.80

Authors: Kati Shihadeh, Heather Young, Bryan Knepper, Timothy Jenkins

Institutions: Denver Health Medical Center, University of Colorado Denver

Language: English

Topic: Antibiotic Use and Resistance

Subfield: Applied Microbiology and Biotechnology

Field: Immunology and Microbiology

Domain: Life Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $4,053