Rapid molecular syndromic testing for aetiological diagnosis of gastrointestinal infections and targeted antimicrobial prescription: experience from a reference paediatric hospital in Spain

• Published in: European journal of clinical microbiology & infectious diseases Vol. 40; no. 10; pp. 2153 - 2160
• Main Authors: Castany-Feixas, Marta, Simo, Silvia, Garcia-Garcia, Selene, Fernandez de Sevilla, Mariona, Launes, Cristian, Kalkgruber, Marlene, Gene, Amadeu, Muñoz-Almagro, Carmen, Brotons, Pedro
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.10.2021; Springer Nature B.V
• Subjects: Algorithms; Antigens; Antiinfectives and antibacterials; Antimicrobial agents; Bacteria - classification; Bacteria - genetics; Bacteria - isolation & purification; Bacterial Infections - diagnosis; Bacterial Infections - microbiology; Biomedical and Life Sciences; Biomedicine; Child; Child, Preschool; Children; Diagnosis; Etiology; Evaluation; Female; Gastrointestinal Diseases - diagnosis; Gastrointestinal Diseases - microbiology; Hospitals, Pediatric - statistics & numerical data; Humans; Infant; Infections; Internal Medicine; Male; Medical Microbiology; Molecular Diagnostic Techniques - instrumentation; Molecular Diagnostic Techniques - methods; Original; Original Article; Parasites; Pediatrics; Prospective Studies; Rotavirus; Spain; Toxins; Spain; Antimicrobial; Multiplex PCR; Diagnosis; Children; Gastrointestinal infection; Molecular test
• ISSN: 0934-9723; 1435-4373; 1435-4373
• DOI: 10.1007/s10096-021-04266-7

Aetiological diagnosis of gastrointestinal infections is challenging since a wide range of bacteria, parasites and viruses can be causal agents and derived clinical manifestations appear quite similar. Our aim was to evaluate contribution of the novel QIAstat-DxGastrointestinal Panel (GIP) to aetiological diagnosis of gastrointestinal infections and rational antimicrobial prescription in a reference paediatric hospital. Evaluation included comparison of diagnostic yield and agreement of results of QIAstat-Dx GIP and conventional microbiological methods. Parallel testing was performed on stool samples collected prospectively from children admitted to Sant Joan de Deu Barcelona Hospital (Spain) during the period February–March 2019 . Influence of the panel test use on antimicrobial prescription was assessed using a pre–post study design. Eighty-six (68.8%) out of 125 specimens were positive by QIAstat-Dx GIP versus 44 (35.2%) positive by a composite of conventional methods ( p <0.001). Global agreement of panel test results with rotavirus-adenovirus antigen detection (92.8%) and a two-step antigen/toxin and PCR-based algorithm for toxigenic Clostridioides difficile detection (87.5%) was greater than that with bacterial culture (76.0%) and parasite microscopic identification (64.3%). Panel test results orientated antimicrobial prescription changes in 18 (14.4%) patients, including antimicrobial start in 11 cases initially untreated, targeted antimicrobial prescription in 5 and discontinuation in 2 cases empirically treated. Results showed that QIAstat-Dx GIP significantly expanded aetiological diagnosis of gastrointestinal infections compared to conventional microbiological methods while orientating a more judicious use of antimicrobial drugs in hospitalised children.