Diagnostic Stewardship for Comprehensive Gastrointestinal Pathogen Panel Tests
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HEALTHCARE ASSOCIATED INFECTIONS (G BEARMAN AND D MORGAN, SECTION EDITORS)
Diagnostic Stewardship for Comprehensive Gastrointestinal Pathogen Panel Tests Jonathan D. Baghdadi 1,2 & K. C. Coffey 1,2 & Surbhi Leekha 1 & J. Kristie Johnson 1,3 & Daniel J. Diekema 4,5 & Daniel J. Morgan 1,2
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Syndromic gastrointestinal (GI) panels are molecular tests that evaluate stool specimens for multiple enteric pathogens simultaneously, including viruses, bacteria, and parasites. The Luminex xTAG GI panel includes 14 microbial targets and the Biofire FilmArray GI panel includes 22. The purpose of this scoping review was to describe clinical use of these two commercially available syndromic GI panels. Recent Findings Compared with conventional testing, syndromic panels increase the number of potential pathogens identified by two- to fivefold. Syndromic panels were associated with non-reproducible results, positive results in the absence of clinical disease, and positive results for pathogens of unclear clinical significance. Syndromic panels were less likely to provide new information when performed > 72 h after hospital admission or when repeated within 4 weeks of a previous test. Process measures or clinical outcomes related to testing were infrequently reported. Summary Outcomes-based research is needed to determine the clinical impact of syndromic GI panels. Strategies for diagnostic stewardship that may increase the utility of GI panels include (1) development of clinical criteria for testing, (2) use of multi-step testing algorithms that start with tests for the most common organisms (Clostridium difficile and norovirus), (3) selective reporting of results, (4) reporting results through a mediator such as the infection preventionist or antibiotic stewardship pharmacist, and (5) maintenance of separate pathways for C. difficile testing. Keywords Diarrheal illness . Gastroenteritis . Molecular diagnostics . Syndromic panel testing . Diagnostic stewardship . Clinical utility
This article is part of the Topical Collection on Healthcare Associated Infections * Jonathan D. Baghdadi [email protected] 1
Department of Epidemiology and Public Health, University of Maryland, College Park, MD 20742, USA
2
Genomic Epidemiology and Clinical Outcomes, Baltimore VA Medical Center, MSTF Suite 33410 S. Pine Street, Baltimore, MD 21201, USA
3
Department of Pathology, University of Maryland, College Park, MD 20742, USA
4
Division of Infectious Diseases, University of Iowa, Iowa City, IA 52242, USA
5
Department of Pathology, University of Iowa, Iowa City, IA 52242, USA
There are an estimated 179 million episodes of acute gastroenteritis in the USA every year [1]. Excluding cases of C. difficile infection, community-acquired diarrheal illness causes 474,000 hospitalizations and 5000 deaths. Beyond morbidity and mortality, episodes of acute gastroenteritis may have economic costs for patents, including the direct costs of healthcar
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