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Gastrointestinal PCR panel enables faster, better antibiotic therapy in kids with infectious diarrhea

Archives of Disease in Childhood
Reuters Health - 18/01/2022 - Using a multiplex gastrointestinal PCR (GI-PCR) panel in children with infectious diarrhea can speed up appropriate prescription of antibiotics, a new study suggests. 

"The GI-PCR's results impacted the medical management of gastroenteritis for almost one-fourth of the children, and especially the prescription of appropriate antibiotic treatment before stool culture results," Dr. Jeanne Truong of the Robert Debre University Hospital, in Paris, and colleagues report in Archives of Disease in Childhood. 

Few studies have examined the impact of using multiplex PCR on pediatric treatment decisions, they researchers note. To investigate, they assessed the use of a GI-PCR panel allowing for simultaneous detection of 22 pathogens in a single stool sample in 172 children (median age, 22 months) with gastroenteritis. 

In patients with diarrhea, indications for stool cultures included mucous/bloody acute diarrhea (76%), traveler's diarrhea (54%), diarrhea lasting more than 15 days (20%), epidemic/family context of diarrhea (14%), severe sepsis (10%), and chronic inflammatory bowel disease (IBD, 6%). 

The median period between stool collection and receipt of GI-PCR results was 21 hours. Prior to sharing GI-PCR results with physicians, approximately 10.5% of children had received treatment with antibiotics. Additionally, 36.6% of patients had been or were hospitalized prior to receiving GI-PCR results. A total of 96 patients (55.8%) returned home with symptomatic therapy. 

The GI-PCRs were positive for most patients (70%). The main pathogens included enteroaggregative E. coli (23%), enteropathogenic E. coli (20%), Shigella/enteroinvasive E. coli (EIEC; 16%), and Campylobacter (12%). 

Compared with stool cultures, GI-PCR detected 21 versus 19 Campylobacter, 12 versus 10 Salmonella, 27 Shigella/EIEC versus 13 Shigella, two versus two Yersinia enterocolitica, and one versus one Plesiomonas shigelloides. 

The GI-PCR results led to a change in medical care for 23.3% of the children before stool-culture results were available. These changes included initiation of antibiotic therapy in 28 patients (16.3%), switching to another antibiotic in two patients (1.2%), discontinuation of antibiotic therapy in one patient (0.6%), one hospitalization (0.6%), isolation of two patients for Clostridioides difficile (1.2%), additional test prescriptions in four patients (2.3%), and two test cancellations (1.2%). 

Dr. Sindhura Thatipelli Batchu, a pediatric gastroenterologist at UC Davis Medical Center in Sacramento, California, said multiplex GI-PCR "is an effective and rapid test that helps us detect which of our patients are presenting with symptoms due to their disease flare versus an infection." 

"With the advent of GI-PCR, we are allowed to make (treatment) decisions much faster, avoid the need for procedures, and possibly reduce hospital stay with more timely treatment," Dr. Batchu, who was not involved in the study, told Reuters Health by email. 

She also noted that, "Given the rapid turnover of the test, there have been instances where a patient was able to be discharged home safely from the emergency room or had a shorter duration of hospital stay after/or lack of source of infection was identified." 

Dr. Batchu suggests future studies are needed to assess the impact of GI-PCR on other aspects of health expenditure, including procedural need and and/or procedural delays. "Similarly, it would also be helpful to see if it resulted in reduced need for abdominal imaging, as this also contributes to extra costs and at times unnecessary radiation to the patient." 

The study had no specific funding, and the researchers report no conflicts of interest. 

Dr. Truong was not immediately available for comment. 

SOURCE: https://bit.ly/3KbXj9Q Archives of Disease in Childhood, online December 17, 2021. 

By Brandon May 

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