Hickey, Patrick, DO

Nellis, Eric, MD

Shnitser, Anastasia, MD

Slenker, Amy, MD

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksDepartment of MedicineRetrospective Review of BioFires FilmArrayGastrointestinal Panels Detection of MultiplePathogens in Adults Patients.Patrick Hickey DOLehigh Valley Health Network, Patrick.Hickey@lvhn.orgEric Nellis MDLehigh Valley Health Network, eric.nellis@lvhn.orgAnastasia Shnitser MDLehigh Valley Health Network, anastasia.shnitser@lvhn.orgAmy Slenker MDLehigh Valley Health Network, amy_k.slenker@lvhn.orgFollow this and additional works at: https://scholarlyworks.lvhn.org/medicinePart of the Gastroenterology Commons, and the Medical Sciences CommonsThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtHickey, P. Nellis, E. Shnitser, A. Slenker, A. (2017, November). Retrospective Review of BioFires FilmArray Gastrointestinal PanelsDetection of Multiple Pathogens in Adults Patients. Poster Presented at: World Congress of Gastroenterology at ACG, Orlando, FL.  References:1.  Guerrant RL, Van Gilder T, Steiner TS, et al. Practice guidelines for the management of infectious diarrhea. Clin Infect Dis. 2001;32(3):331-351. doi:10.1086/318514.2.  Zhang H, Morrison S, Tang Y-W. Multiplex Polymerase Chain Reaction Tests for Detection of Pathogens Associated with Gastroenteritis. Clin Lab Med. 2015;35(2):461-486. doi:10.1016/j.cll.2015.02.006.3.  Buss SN, Leber A, Chapin K, et al. Multicenter evaluation of the BioFire FilmArray gastrointestinal panel for etiologic diagnosis of infectious gastroenteritis. J Clin Microbiol. 2015;53(3):915-925. doi:10.1128/JCM.02674-14.4.  Mengelle C, Mansuy JM, Prere MF, et al. Simultaneous detection of gastrointestinal pathogens with a multiplex Luminex-based molecular assay in stool samples from diarrhoeic patients. Clin Microbiol Infect. 2013;19(10). doi:10.1111/1469-0691.12255.© 2017 Lehigh Valley Health NetworkRetrospective Review of BioFire’s FilmArray Gastrointestinal Panel’s Detection of Multiple Pathogens in Adult Patients: A Hypothesis Generating Study•  Our study highlights a high frequency (16.8%) of pathogen co-detection in patients with a positive stool PCR test•  It also suggests that bacterial-viral co-detections are the most commonly identified combination•  The most frequent pathogen-specific combination was Norovirus with C. difficile accounting for 19.3% of co-detections•  More information is needed on the significance of co-detections and their treatment•  Further analysis will evaluate the contribution of demographics and immunosuppressing conditions to the likelihood of co-detection•  Pathogens are only identified in 1.5 to 5.6 percent of stool cultures for acute diarrhea1  •  Multiplex stool PCR is an accurate diagnostic tool to detect multiple intestinal pathogens in a single sample with rapid turnaround and high sensitivity/specificity •  BioFire’s FilmArray Gastrointestinal Panel is an FDA approved syndromic multiplex PCR assay which evaluates stool for 22 common bacterial, viral and parasitic targets  –  Campylobacter spp., Clostridium difficile toxins, Plesiomonas shigelloides, Salmonella, Yersinia enerocolitica, Vibrio spp., Diarrheagenic E. coli/Shigella, Enteroaggregative E. coli, Enteropathogenic E. coli, Enterotoxigenic E. coli, Shiga-like toxin-producing E. coli, Shigella/Enteroinvasive E. coli, Cryptosporidium, Cyclospora cayetanensis, Entamoeba histolytica, Giardia lamblia, Adenovirus, Astrovirus, Norovirus, Rotavirus A, and Sapovirus•  Major advantages include rapid turnaround time, identification of coinfections, high negative predictive value which decreases the use of infection control precautions, and high sensitivity and specificity2•  The test’s sensitivity ranges between 94.5%-100% and specificity ranges between 97.1-100%3•  In studies using multiplex assays there has been a notable increase in the detection of multiple pathogens within one stool sample.  One study found as many as 31.5% of stool samples that were positive had multiple pathogens detected; another study found that 18% of immunosuppressed patients with positive stool test were coinfected3-4•  Currently the clinical implication of detecting multiple pathogens is poorly understood•  The study was designed as a retrospective, descriptive, hypothesis-generating study to evaluate the co-detection of pathogens with BioFire FilmArray Gastrointestinal Panel in an adult community population•  Patients with stool PCR positive for ≥1 pathogen within the date range of 01/01/15-06/30/16 were obtained•  Inclusion criteria was age ≥18 and having a stool PCR with ≥1 pathogen within a community health network in the study date range•  Patients with tests repeated within 14 days of initial sample were excluded from the analysis•  Demographic data at the time of sample collection were obtained•  710 patients with pathogen detection•  119 patients with a pathogen detected had >1 pathogen (16.8%)•  Bacterial-viral co-detections were seen in 50.4% of co-detection samples, while 39.5% of co-detections were bacterial-bacterial (Table 1)•  Viral-viral, bacterial-parasitic, and bacterial-parasitic-viral co-detections were less frequent •  Certain organisms when positive on stool PCR testing, had a ≥50% occurrence as a co-detection rather than in isolation:  –  E. coli O157:H7 100% (1/1), P. shigelloides 83% (5/6), Sapovirus 70.6% (12/17), EAEC 62.9% (22/35), and Cryptosporidium 50% (3/6) when positive on stool PCR testing •  The most common patterns of co-detection were Norovirus/C. difficile (19.3%), EPEC/C. difficile (7.6%), EPEC/Campylobacter (5.9%), and EPEC/Norovirus (5.9%) (Table 2)•  Currently the clinical implication of detecting multiple pathogens is poorly understoodLehigh Valley Health Network, Allentown, Pennsylvania Patrick Hickey, DO, Eric Nellis, MD, Anastasia Shnitser, MD, and Amy Slenker, MDDISCUSSIONRESULTSINTRODUCTIONTable 1.  Organism Classification in Co-DetectionsCo-detection Pathogen Classification Incidence in Co-detectionsBacterial-Viral 50.4% (60/119)Bacterial-Bacterial 39.5% (47/119)Viral-Viral 5.0% (6/119)Bacterial-Parasitic 3.4% (4/119)Bacterial-Parasitic-Viral 1.7% (2/119)METHODS Table 2.  Incidence of PathogensHighest Incidence of Co-Detected Pathogens IncidenceC. difficile, Norovirus 19.3% (23/119)C. difficile, EPEC 7.6% (9/119)Campylobacter, EPEC 5.9% (7/119)EPEC, Norovirus 5.9% (7/119)C. difficile, EAEC 4.2% (5/119)EAEC, EPEC 4.2% (5/119)

Retrospective Review of BioFires FilmArray Gastrointestinal Panels Detection of Multiple Pathogens in Adults Patients.

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Retrospective Review of BioFires FilmArray Gastrointestinal Panels Detection of Multiple Pathogens in Adults Patients.

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