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Published on: June 11, 2011
Comparison of Multiplex Gastrointestinal Pathogen Panel and Conventional Stool Testing for Evaluation of Patients
Juliana Sobczyk1, Sonia Jain2, Xiaoying Sun2
1Department of Pathology, University of California, San Diego, La Jolla, California, USA.
Background:
Gastrointestinal pathogen panels (GPPs) are increasingly used to identify stool pathogens, but their impact in people with HIV (PWH) is unknown. We performed a retrospective cohort study comparing GPP and conventional stool evaluation in PWH.
Methods:
We included all PWH who underwent GPP (Biofire Diagnostics; implemented September 15, 2015) or conventional testing, including stool culture, Clostridium difficile polymerase chain reaction testing, fluorescent smears for Cryptosporidium or Giardia, and ova and parasite exams (O&P) from 2013 to 2017. A total of 1941 specimens were tested, with 169 positive specimens detected in 144 patients. We compared result turnaround time, pathogen co-infection, antibiotic treatment, and treatment outcomes between positive specimens detected by conventional testing vs GPP.
Results:
Overall, 124 patient samples tested positive by GPP, compared with 45 patient specimens by conventional testing. The GPP group demonstrated a higher co-infection rate (48.4% vs 13.3%; P < .001) and quicker turnaround time (23.4 vs 71.4 hours; P < .001). The GPP identified 29 potential viral infections that were undetectable by conventional stool tests. Unnecessary anti-infective therapy was avoided in 9 of 11 exclusively viral infections. Exclusively nonpathogenic parasites (n = 13) were detected by conventional stool tests, the majority of which were treated with metronidazole. There were no significant differences in clinical outcomes between groups.
Conclusions:
In PWH, GPP implementation improved antibiotic stewardship through shorter turnaround times and detection of enteric viral pathogens.
Insights
Gastrointestinal pathogen panels (GPPs) in people with HIV (PWH) significantly reduce diagnostic time and improve antibiotic stewardship by detecting viral pathogens missed by conventional testing.
Area of Science:
- Infectious Diseases
- Clinical Microbiology
- HIV Medicine
Background:
- Gastrointestinal pathogen panels (GPPs) are increasingly utilized for stool pathogen identification.
- The clinical impact of GPPs in people with HIV (PWH) remains largely uncharacterized.
Purpose of the Study:
- To compare the diagnostic yield and clinical impact of GPP versus conventional stool testing in PWH.
- To evaluate turnaround time, co-infection rates, and treatment outcomes between GPP and conventional methods.
Main Methods:
- A retrospective cohort study compared GPP (Biofire Diagnostics) with conventional stool testing (stool culture, C. difficile PCR, Cryptosporidium/Giardia smears, O&P) in PWH from 2013-2017.
- 1941 specimens were analyzed, focusing on 169 positive results from 144 patients.
- Key metrics included turnaround time, pathogen co-infection, antibiotic use, and clinical outcomes.
Main Results:
- GPP identified more positive specimens (124 vs. 45) and demonstrated higher co-infection rates (48.4% vs. 13.3%).
- GPP offered significantly faster turnaround times (23.4 vs. 71.4 hours) and detected 29 viral infections missed by conventional methods.
- Appropriate antibiotic stewardship was improved, avoiding unnecessary treatment in viral infections, though clinical outcomes did not differ significantly.
Conclusions:
- GPP implementation in PWH enhances antibiotic stewardship via reduced turnaround times and identification of enteric viral pathogens.
- GPP represents a valuable tool for diagnosing gastrointestinal infections in PWH, improving diagnostic efficiency and antimicrobial prescribing.
