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Updated: Aug 8, 2025
A High-throughput Platform for the Screening of Salmonella spp./Shigella spp.
Published on: November 7, 2018
Impact of Rapid Molecular Multiplex Gastrointestinal Pathogen Testing in Management of Children during a Shigella
N Kanwar1,2, J Jackson1, T Bardsley3
1Children's Mercy Hospitals and Clinics, Kansas City, Missouri, USA.
Abstract:
Fecal culture for isolation and identification of Shigella may take days. The BioFire FilmArray Gastrointestinal (GI) panel (bioMérieux, France) is a PCR-based assay that detects enteric pathogens including Shigella/enteroinvasive Escherichia coli (EIEC) in about an hour. The aim of this study was to evaluate the impact of GI panel detection of Shigella in a pediatric emergency department (ED) during an outbreak. Stool samples from children with acute gastroenteritis were tested by the GI panel. Test results were either withheld in preintervention (PRE) or reported to clinicians/families in the postintervention (POST) period. The impact of the GI panel testing on patient management and outcomes was measured. Shigella/EIEC was identified by the GI panel in the PRE (n = 30) and POST (n = 21) phase. The GI panel detected more Shigella infections than did culture; six of 31 (19.4%) Shigella GI panel-positive patients who also had stool cultures were missed by culture. Azithromycin therapy was prescribed for 20% of subjects in the PRE phase and 71.4% of subjects in the POST phase (P < 0.001). Time from the clinical encounter until starting azithromycin therapy was shorter in the POST phase (n = 9), 8.25 h (range, 6.37 to 52.37 h), than in the PRE phase (n = 1), 72 h. Six subjects in the PRE phase visited additional providers compared with one in the POST phase. Prompt diagnosis of shigellosis with the GI panel may provide the opportunity for prompt antimicrobial therapy and avoid additional visits to providers due to early definitive diagnosis. Prompt diagnosis of Shigella at an ED visit may optimize patient management and reduce transmission.
Insights
The BioFire FilmArray Gastrointestinal (GI) panel rapidly detects Shigella, improving patient management. Prompt diagnosis via the GI panel led to faster azithromycin treatment and fewer additional healthcare visits for children with shigellosis.
Area of Science:
- Clinical microbiology
- Infectious diseases
- Pediatric emergency medicine
Background:
- Traditional fecal culture for Shigella identification is time-consuming, delaying diagnosis and treatment.
- The BioFire FilmArray Gastrointestinal (GI) panel offers rapid PCR-based detection of enteric pathogens, including Shigella/enteroinvasive Escherichia coli (EIEC), within an hour.
Purpose of the Study:
- To evaluate the impact of rapid GI panel detection of Shigella on patient management and outcomes in a pediatric emergency department (ED) during an outbreak.
- To compare the diagnostic performance of the GI panel with traditional stool culture for Shigella detection.
Main Methods:
- A prospective study was conducted in a pediatric ED, comparing a pre-intervention (PRE) period where GI panel results were withheld with a post-intervention (POST) period where results were reported.
- Stool samples from children with acute gastroenteritis were tested using the GI panel, with a subset also undergoing traditional culture.
- Patient management, treatment, and healthcare utilization were compared between the PRE and POST periods.
Main Results:
- The GI panel detected more Shigella infections than stool culture, with six of 31 (19.4%) positive cases missed by culture.
- Azithromycin therapy was prescribed significantly more often in the POST phase (71.4%) compared to the PRE phase (20%) (P < 0.001).
- Time to azithromycin initiation was shorter in the POST phase (8.25 hours) versus the PRE phase (72 hours), and fewer patients in the POST phase required additional provider visits (1 vs. 6).
Conclusions:
- Rapid detection of Shigella using the GI panel in a pediatric ED setting optimizes patient management by enabling prompt antimicrobial therapy.
- The GI panel's speed and sensitivity improve upon traditional culture methods, leading to faster treatment and reduced healthcare resource utilization.
- Prompt diagnosis and treatment of shigellosis can potentially reduce transmission and improve patient outcomes.
