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Impact of Culture-Independent Diagnostic Testing on Recovery of Enteric Bacterial Infections

Aamer Imdad1, Fiona Retzer2, Linda S Thomas2

  • 1D. Brent Polk Division of Pediatric Gastroenterology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee.

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
|January 3, 2018
PubMed
Abstract

Insights

Culture-independent diagnostic tests (CIDTs) show lower pathogen recovery for enteric bacteria. This impacts foodborne illness surveillance, outbreak detection, and public health costs.

Area of Science:

  • Foodborne illness surveillance
  • Public health laboratory diagnostics
  • Molecular subtyping

Background:

  • Culture-independent diagnostic tests (CIDTs) are increasingly utilized for enteric pathogen identification.
  • Traditional foodborne illness surveillance relies on culture confirmation for disease burden estimation and outbreak detection.
  • This study evaluated the impact of CIDTs on pathogen recovery and culture verification costs for key enteric bacteria at a public health laboratory.

Purpose of the Study:

  • To assess the pathogen recovery rates from specimens initially tested by CIDTs compared to culture-based methods.
  • To estimate the associated costs of culture verification for Shigella, Salmonella, Shiga toxin-producing Escherichia coli (STEC), and Campylobacter.
  • To understand the implications of CIDT use on public health surveillance systems.

Main Methods:

  • An observational study utilizing laboratory and epidemiological data from 2013-2016.
  • Calculation of pathogen recovery rates based on initial diagnostic test type (CIDT vs. culture).
  • Modified Poisson regression used to estimate prevalence ratios; cost analysis compared CIDT-positive specimen recovery to culture-derived isolates.

Main Results:

  • Pathogen recovery was significantly lower from CIDT-positive specimens (57%) compared to culture-derived isolates (95%).
  • Recovery rates varied by pathogen: Salmonella (72%), Shigella (64%), STEC (57%), and Campylobacter (26%) from CIDT-positive specimens.
  • Culture verification costs for 100 CIDT-positive specimens were higher for Shigella, Salmonella, and STEC compared to culture-derived isolates.

Conclusions:

  • Low pathogen recovery from CIDT-positive specimens poses challenges for enteric disease surveillance.
  • Current surveillance systems may underestimate disease burden and impact outbreak detection capabilities.
  • The findings highlight significant cost implications for public health programs relying on culture verification.

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