scholarly journals Rapid Molecular Detection of Gastrointestinal Pathogens and Its Role in Antimicrobial Stewardship

2018 ◽  
Vol 56 (5) ◽  
Author(s):  
Şiran Keske ◽  
Burak Zabun ◽  
Kahraman Aksoy ◽  
Füsun Can ◽  
Erhan Palaoğlu ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Acute Diarrhea ◽  
Salt Lake ◽  
Salt Lake City ◽  
Antibiotic Use ◽  
Stool Culture ◽  
Content Type ◽  
E Coli ◽  
Lake City ◽  
The Impact

ABSTRACT We aimed to detect the etiological agents of acute diarrhea by a molecular gastrointestinal pathogen test (MGPT) and to assess the impact of MGPT on antimicrobial stewardship programs (ASP). This is a prospective observational study and was conducted between 1 January 2015 and 30 June 2017. We included consequent patients who had acute diarrhea. At the end of 2015, we implemented ASP in acute diarrhea cases and compared the outcomes in the pre-ASP and post-ASP periods. An FDA-cleared multiplexed gastrointestinal PCR panel system, the BioFire FilmArray (Idaho Technology, Salt Lake City, UT), which detects 20 pathogens in stool, was used. In 499 out of 699 patients (71%), at least one pathogen was detected. Among 314 adults with positive MGPT, 101 (32%) enteropathogenic Escherichia coli (EPEC), 71 (23%) enteroaggregative E. coli (EAEC), 68 (22%) enterotoxigenic E. coli (ETEC), 55 (18%) Shiga toxin-producing E. coli (STEC) (17%) Norovirus , 48 (15%) Campylobacter , 21 (7%) Salmonella , and 20 (6%) Clostridium difficile strains were detected. Among 185 children, 55 (30%) EPEC, 37 (20%) C. difficile , 32 (17%) Norovirus , 29 (16%) EAEC, 22 (12%) STEC, 21 (11%) ETEC, 21 (11%) Campylobacter , 20 (11%) Salmonella , and 16 (5%) Rotavirus strains were detected. Inappropriate antibiotic use decreased in the post-ASP period compared with the pre-ASP period among inpatients (42.9% and 25.8%, respectively; P = 0.023). Using MGPT in clinical practice significantly decreased the unnecessary use of antibiotics. Detection of high rates of C. difficile in children and Salmonella spp., as well as relatively high rates of Campylobacter spp., which were hard to isolate by routine stool culture, were remarkable.

scholarly journals Use of BioFire FilmArray gastrointestinal PCR panel associated with reductions in antibiotic use, time to optimal antibiotics, and length of stay.

2020 ◽  
Author(s):  
Daisy Torres-Miranda ◽  
Hana Akselrod ◽  
Ryan Karsner ◽  
Alessandra Secco ◽  
Diana Silva-Cantillo ◽  
...  
Keyword(s):  
Salt Lake ◽  
Salt Lake City ◽  
Length Of Hospital Stay ◽  
Antibiotic Use ◽  
Stool Culture ◽  
Diagnostic Tools ◽  
Lake City ◽  
The Impact ◽  
Multiple Pathogens ◽  
Stool Cultures

Abstract BACKGROUND: Rapid and accurate diagnostic tools are needed for appropriate management of infectious diarrhea. METHODS: We evaluated the impact of the introduction of rapid multiplex PCR testing using the FilmArray gastrointestinal (GI) panel (BioFire Diagnostics, LLC, Salt Lake City, UT) at our institution, and compared the results to those of standard stool cultures. RESULTS: The most common pathogens detected by the FilmArray GI panel were Clostridium difficile (55.0%), Campylobacter species (20.9%), Salmonella species (12.4%), and Shigella/EIEC species (12.4%). Rates of reproducibility in stool culture for these pathogens ranged from 56.3% to 77.8%. Co-detection of two or more organisms was common (24.2%), most commonly involving EPEC, EAEC, ETEC, and STEC. The time from arrival in the Emergency Department to discharge or admission to the hospital was unchanged after the introduction of FilmArray GI panel, but length of hospital stay was shorter (3 vs. 7.5 days, p=0.0002) for the FilmArray group. The time to empiric antibiotics did not differ significantly, but optimal antibiotics were started earlier after introduction of the FilmArray GI panel (hospital day 1 vs. 2, p<0.0001). More patients were discharged without antibiotics after introduction of the FilmArray GI panel (14.0% vs. 4.5%; p<0.001). CONCLUSION: Our results demonstrate that the FilmArray GI panel is an important tool for improving both patient care and antibiotic stewardship, despite the tendency for positive results with multiple pathogens.

scholarly journals Use of BioFire FilmArray gastrointestinal PCR panel associated with reductions in antibiotic use, time to optimal antibiotics, and length of stay.

2020 ◽  
Author(s):  
Daisy Torres-Miranda ◽  
Hana Akselrod ◽  
Ryan Karsner ◽  
Alessandra Secco ◽  
Diana Silva-Cantillo ◽  
...  
Keyword(s):  
Salt Lake ◽  
Salt Lake City ◽  
Length Of Hospital Stay ◽  
Antibiotic Use ◽  
Stool Culture ◽  
Diagnostic Tools ◽  
Lake City ◽  
The Impact ◽  
Multiple Pathogens ◽  
Stool Cultures

Abstract Rapid and accurate diagnostic tools are needed for appropriate management of infectious diarrhea. We evaluated the impact of the introduction of rapid multiplex PCR testing using the FilmArray gastrointestinal (GI) panel (BioFire Diagnostics, LLC, Salt Lake City, UT) at our institution, and compared the results to those of standard stool cultures. The most common pathogens detected by the FilmArray GI panel were Clostridium difficile (55.0%), Campylobacter species (20.9%), Salmonella species (12.4%), and Shigella/EIEC species (12.4%). Rates of reproducibility in stool culture for these pathogens ranged from 56.3% to 77.8%. Co-detection of two or more organisms was common (24.2%), most commonly involving EPEC, EAEC, ETEC, and STEC. The time from arrival in the Emergency Department to discharge or admission to the hospital was unchanged after the introduction of FilmArray GI panel, but length of hospital stay was shorter (3 vs. 7.5 days, p=0.0002) for the FilmArray group. The time to empiric antibiotics did not differ significantly, but optimal antibiotics were started earlier after introduction of the FilmArray GI panel (hospital day 1 vs. 2, p<0.0001). More patients were discharged without antibiotics after introduction of the FilmArray GI panel (14.0% vs. 4.5%; p<0.001). Our results demonstrate that the FilmArray GI panel is an important tool for improving both patient care and antibiotic stewardship, despite the tendency for positive results with multiple pathogens.

scholarly journals Low Yield of FilmArray GI Panel in Hospitalized Patients with Diarrhea: an Opportunity for Diagnostic Stewardship Intervention

2017 ◽  
Vol 56 (3) ◽  
Author(s):  
Matthew M. Hitchcock ◽  
Carlos A. Gomez ◽  
Niaz Banaei
Keyword(s):  
Salt Lake ◽  
Diagnostic Yield ◽  
Salt Lake City ◽  
Stool Culture ◽  
False Positives ◽  
Hospitalized Patients ◽  
Adult Patients ◽  
Content Type ◽  
Infectious Gastroenteritis ◽  
Lake City

ABSTRACTThe FilmArray GI panel (BioFire Diagnostics, Salt Lake City, UT) is a multiplex, on-demand, sample-to-answer, real-time PCR assay for the syndromic diagnosis of infectious gastroenteritis that has become widely adopted and, in some instances, has replaced conventional stool culture and parasite exams. Conventional testing has historically been restricted among hospitalized patients due to low diagnostic yield, but it is not known whether use of the FilmArray GI panel should be circumscribed. Cary-Blair stool samples submitted for FilmArray GI panel in adult patients admitted to an academic hospital from August 2015 to January 2017 were included in this study. Of 481 tests performed >72 h after admission, 29 (6.0%) were positive, all for a single target, excludingClostridium difficile. When follow-up tests beyond the first positive per hospitalization were excluded, 20 (4.8%) of 414 tests were positive. There was no difference in yield by immune status. Most targets detected were viral (79% of all positives [n= 23] and 70% in unique patients [n= 14]). All four cases positive for a bacterial target could not be confirmed and presentation was atypical, suggesting possible false positives. After removing potential false positives and chronic viral shedders, the yield was 3.0% (12/406). Repeat testing performed >72 h after admission and following a negative result within the first 72 h was done in 19 patients and 100% (22/22) remained negative. The FilmArray GI panel has low yield in adult patients hospitalized for >72 h, similar to conventional stool microbiology tests, and it is reasonable to restrict its use in this population.

scholarly journals Clinical Yield of Routine Use of Molecular Testing for Adult Outpatients with Diarrhea

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S33-S33
Author(s):  
Stephen Clark ◽  
Michael Sidlak ◽  
Amy Mathers ◽  
Melinda Poulter ◽  
James Platts-Mills
Keyword(s):  
Change Management ◽  
Salt Lake ◽  
Salt Lake City ◽  
Turnaround Time ◽  
Antimicrobial Treatment ◽  
Molecular Testing ◽  
Travel History ◽  
E Coli ◽  
Lake City ◽  
The Cost

Abstract Background Molecular diagnostics for enteropathogens increase yield while reducing turnaround time. However, many pathogens do not require specific therapy, and the cost is substantial. Methods We reviewed the use of the FilmArray GI Panel (BioFire Diagnostics, Salt Lake City, Utah) in adult outpatients at the University of Virginia and identified clinical features that could limit testing without reducing yield. We defined yield as (a) detection of a pathogen, (b) detection of a pathogen for which antimicrobial therapy is indicated, or (c) detection of a pathogen that can change management, which additionally included viral pathogens in immunocompromised patients. Results Between March 23, 2015 and February 25, 2016, we reviewed 452 tests from adult outpatients with diarrhea. A pathogen was detected in 88/452 (19.5%). The most common pathogens were: enteropathogenic E. coli (36; 8.0%), norovirus (17; 3.8%), Campylobacter (7, 1.5%), enteroaggregative E. coli (6, 1.3%), Giardia (6; 1.3%), and sapovirus (5; 1.1%). Based on clinical guidelines, antimicrobial treatment was clearly indicated for 19/452 subjects (4.2%). Limiting testing to patients with an additional enteric symptom (abdominal pain, nausea, vomiting, fecal urgency, tenesmus, or flatulence), a travel history, or an immunocompromising condition would reduce testing by 25.9%, with a treatable pathogen identified in 18/331 (5.4%) (sensitivity 94.7%, specificity 27.7%). Further modifying testing criteria to exclude subjects with vomiting, 18/288 (6.3%) had a treatable pathogen (sensitivity 94.7%, specificity 37.3%), and a pathogen which could change management was detected in 28/288 (9.7%) (sensitivity 96.6%, specificity 38.5%). Excluding immunocompromised subjects or those with a travel history, American College of Gastroenterology guidelines for testing were met by 293/348 (84.2%) with a documented duration of diarrhea, and a treatable pathogen was detected in 8/293 (2.7%) vs. 3/55 (5.5%) who did not meet testing guidelines. Conclusion Testing could be reduced by 36.3% without decreasing clinical yield by limiting testing to patients with diarrhea with an additional enteric symptom and no history of vomiting, a travel history, or an immunocompromising condition. ACG guidelines did not improve testing efficiency. Disclosures All authors: No reported disclosures.

Shadowed by the corpse of war: Sport spectacles and the spirit of terrorism

2012 ◽  
Vol 47 (3) ◽  
pp. 286-306 ◽  
Author(s):  
Michael Atkinson ◽  
Kevin Young
Keyword(s):  
Olympic Games ◽  
Salt Lake ◽  
Management Strategies ◽  
Salt Lake City ◽  
Mega Events ◽  
Sports Events ◽  
Risk Management Strategies ◽  
Winter Olympic Games ◽  
Lake City ◽  
The Impact

Since the early 2000s, there has been a groundswell of research on terrorism and sports mega-events, including investigations into the impact of ‘9/11’ on fear and risk management strategies at high profile sports events. In this article, we re-examine the case of the Salt Lake City Winter Games of 2002 around Baudrillard’s (1995) concept of the ‘non-event’. We compare the (largely British and North American) mass mediation and discursive framing of terrorism at the 2002 Games with subsequent discourses interwoven into accounts of terrorism, fear and security at the 2004 Summer Olympic Games in Athens and the 2006 Winter Olympic Games in Turin. Of principal interest is the global framing of sports mega-events as targets of terrorism and the ways in which such events become fabricated zones of risk. To understand why there is a lingering media construction of the sports mega-event as an imagined target (and, in many ways, pre-constructed victim) of terrorism, we draw centrally on Baudrillard’s work (1995, 2001, 2002a, 2002b). Specifically, we employ Baudrillard’s concepts of the hyperreal and the non-event as a means of exploring terrorism’s relationship with sport, and the potential usage of such theoretical ideas in the sociology of sport and physical culture more broadly.

Addressing the Irish world: Éamon de Valera's ‘Cuban policy’ as a global case study

2020 ◽  
Vol 44 (165) ◽  
pp. 41-56
Author(s):  
Darragh Gannon
Keyword(s):  
United States ◽  
New York ◽  
Salt Lake ◽  
Salt Lake City ◽  
The United States ◽  
Foreign Experience ◽  
Irish Republic ◽  
Lake City ◽  
The Impact

AbstractWriting in Nationalist revolutionaries in Ireland, 1858–1928, Tom Garvin observed that ‘well over 40 per cent, perhaps 50 per cent, had lived outside Ireland for considerable periods … foreign experience was very important in the development of the leaders’. The impact of ‘foreign experience’ on leading nationalist revolutionaries, this article submits, pace Garvin, could have proved influential in the development of the Irish Revolution more widely. Between June 1919 and December 1920, Éamon de Valera toured the United States. From New York City to Salt Lake City, Alabama to Montana, the self-proclaimed president of the Irish republic addressed ‘Ireland’ in hundreds of interviews and speeches. Of these myriad public statements, his Cuban missive, notably, crossed national boundaries. Comparing Ireland's geo-strategic relationship with Great Britain to that of Cuba and the United States, de Valera's argument for an independent Irish republic was made in the Americas. How did de Valera's movement across the U.S. alter his political views of Ireland? How were presentations of de Valera's ‘Cuban policy’ mediated across the ‘Irish world’? How did discourse on the Monroe Doctrine inform Anglo-Irish negotiations between Truce and Treaty? Exploring de Valera's ‘Cuban policy’ as global case study, this article concludes, ultimately, can shift the historiographical significance of ‘foreign experience’ from nationalist revolutionaries in Ireland to the flows and circulation of transnational revolution.

scholarly journals Clinical Characteristics of Diarrheal Illness with Enteropathogenic E. coli (EPEC) Diagnosed with FilmArray (BioFire Diagnostics, Salt Lake City, UT) Multiplex PCR (MPCR) Testing. Maria Georgen BS, Paul Schreckenberger, PhD, Paul O’Keefe MD. Loyola University Medical Center, Maywood, Illinois, USA

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S363-S363
Author(s):  
Maria Georgen
Keyword(s):  
Salt Lake ◽  
Medical Center ◽  
Diagnostic Testing ◽  
Salt Lake City ◽  
Stool Culture ◽  
Urgent Care ◽  
Sample Collection ◽  
Patients Âgés ◽  
E Coli ◽  
Diarrheal Illness

Abstract Background EPEC is a known cause of diarrhea, predominately in children, which has not been identified with conventional stool culture in most medical centers. MPCR testing assesses stool samples in which DNA targets for 20 or more pathogens are tested with rapid turnaround. This method has become the standard for diagnostic testing in many clinical laboratories. MPCR testing has identified EPEC as among the most frequent pathogens in published studies. Methods We have completed a retrospective review of medical records of patients who tested positive for EPEC in our medical center. Results EPEC was found in 56 of 332 MPCR samples analyzed between February 1, 2016 and July 31, 2016. EPEC was the only pathogen in 25 while co-infecting pathogens were found in 31. Co-infections included other diarrhea-causing E. coli (ETEC, EAEC and EIEC but none with STEC) in 17, C. difficile in 7, viruses (astrovirus 3, sapovirus 2, norovirus 2, rotavirus 2), Campylobacter 3, Giardia 2, Salmonella 2, Pleisiomonas 1 and Yersinia 1. Patients ages ranged from &lt;1 to 100 with 37 over age 19. Half were female. 7/46 had received antibiotic prior to sample collection. 10 reported recent travel. 51/52 presented to the emergency department, urgent care centers or ambulatory clinics. Symptoms included fever in 15/54, nausea 16/54, vomiting 14/54 and abdominal pain in 17/56. Diarrhea was described as watery in 23/32 and bloody in only 3. Antibiotic treatment was prescribed for 6/24 with EPEC only and for 22/31 with coinfection. A follow-up encounter was documented for 24 patients with EPEC only: 13 resolved, 3 remained ill and 8 could not be assessed. Conclusion EPEC is frequently found in stools from persons with diarrhea when MPCR is employed. Symptoms cannot be attributed to EPEC alone when other pathogens are found, but our analysis does suggest that EPEC is a common cause of diarrheal illness in adults as well as children. Prospective studies on natural history and treatment are necessary. Disclosures All authors: No reported disclosures.

scholarly journals Is Follow-Up Testing with the FilmArray Gastrointestinal Multiplex PCR Panel Necessary?

2017 ◽  
Vol 55 (4) ◽  
pp. 1154-1161 ◽  
Author(s):  
Sholhui Park ◽  
Matthew M. Hitchcock ◽  
Carlos A. Gomez ◽  
Niaz Banaei
Keyword(s):  
Positive Result ◽  
Salt Lake ◽  
Salt Lake City ◽  
Initial Result ◽  
Nucleic Acid Amplification ◽  
Content Type ◽  
E Coli ◽  
Infectious Gastroenteritis ◽  
Conversion Rates

ABSTRACT The FilmArray gastrointestinal (GI) panel (BioFire Diagnostics, Salt Lake City, UT) is a simple, sample-to-answer, on-demand, multiplex, nucleic acid amplification test for syndromic diagnosis of infectious gastroenteritis. The aim of this study was to measure the yield of follow-up testing with FilmArray GI panel within 4 weeks of an initial test. Consecutive adult and pediatric patients tested at an academic institution between August 2015 and June 2016 were included in this study. Of 145 follow-up tests in 106 unique patients with an initial negative result, 134 (92.4%) tests and 98 (92.5%) patients remained negative upon follow-up testing. Excluding targets that are not reported at this institution ( Clostridium difficile , enteroaggregative Escherichia coli , enteropathogenic E. coli , and enterotoxigenic E. coli ), 137 (94.5%) follow-up tests and 101 (95.3%) patients remained negative. Weekly conversion rates were not significantly different across the 4-week follow-up interval. No epidemiological or clinical factors were significantly associated with a negative to positive conversion. Of 80 follow-up tests in patients with an initial positive result, 43 (53.8%) remained positive for the same target, 34 (42.5%) were negative, and 3 were positive for a different target (3.8%). Follow-up testing with FilmArray GI panel within 4 weeks of a negative result rarely changed the initial result, and the follow-up test reverted to negative less than half the time after an initial positive result. In the absence of clinical or epidemiological evidence for a new infection, follow-up testing should be limited and FilmArray GI panel should not be used as a test of cure.

Estimating CO2 Emissions Reductions With EnergyPlus for an Office Building in Salt Lake City

2014 ◽  
Author(s):  
Stephen M. Lucich ◽  
Amanda D. Smith
Keyword(s):  
Co2 Emissions ◽  
Salt Lake ◽  
Salt Lake City ◽  
Ghg Emissions ◽  
Office Building ◽  
Solar Irradiation ◽  
Weather Data ◽  
Emissions Reductions ◽  
Lake City ◽  
The Impact

This research estimates the achievable CO2 emissions reductions for a medium sized office building located in Salt Lake City, Utah. Four strategies that required minor retrofits or changes to a building’s operational controls were considered: automatic window shading, changes in window construction, lighting intensity, and temperature setpoint adjustment. Since 70% of energy consumed by the building sector is for heating, cooling and lighting, the methods introduced were targeted to reduce these sources of demand. The model building used was selected from the U.S. DOE’s commercial reference buildings. The simulations were run using the DOE’s EnergyPlus building energy modeling software and a TMY3 weather data file for Salt Lake City. The effect of these possible building changes on energy consumption and the CO2 emissions resulting from the production of this energy were examined. The impact of the automatic window shade was the lowest of the strategies considered with a 1% reduction in GHG emissions. This is likely the result of a low solar irradiation area to building volume ratio and should be explored for smaller residential and commercial buildings. Window construction was more promising with GHG emissions reductions between 2% and 6%. Lighting strategies and altered temperature set points demonstrated GHG emissions reduction of up to 15%. This research establishes a technique to evaluate building emissions reductions with respect to location, building construction, and operation.

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