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 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.

Preventing Adverse Drug Events in Hospitalized Patients

1994 ◽  
Vol 28 (4) ◽  
pp. 523-527 ◽  
Author(s):  
R. Scott Evans ◽  
Stanley L. Pestotnik ◽  
David C. Classen ◽  
Susan D. Horn ◽  
Sheron B. Bass ◽  
...  
Keyword(s):  
Adverse Drug Events ◽  
Salt Lake ◽  
Care Center ◽  
Tertiary Care ◽  
Salt Lake City ◽  
Hospitalized Patients ◽  
Drug Event ◽  
Antibiotic Administration ◽  
Type B ◽  
Lake City

OBJECTIVE: To use computerized adverse drug event (ADE) surveillance to help identify methods to reduce the number of ADEs in hospitalized patients. DESIGN: Prospective study of 79 719 hospitalized patients during a 44-month period. SETTING: LDS Hospital, a 520-bed tertiary care center affiliated with the University of Utah School of Medicine, Salt Lake City. INTERVENTION: Sequential study periods of at least one year each were compared. In the first period, data were collected but not reported to physicians, pharmacists, or nurses. In the subsequent study periods, three interventions (computerized alerts of drug allergies, standardized antibiotic administration rates, and timely physician notification of all ADEs) were made to reduce the number of type B (allergic or idiosyncratic reactions) and severe ADEs. RESULTS: In the first study period, we identified 56 type B ADEs during 120 213 patient days. During two subsequent study periods that included alerts to physicians of known drug allergies and standardized antibiotic administration rates, 8 type B events were identified during 113 237 patient days and 18 during 107 868 patient days, respectively (p<0.OO2). Early notification of physicians of all confirmed ADEs regardless of severity was associated with asignificant reduction of ADEs classified as severe from 41 during 113 859 patient days in the first study period to 12 during 103 071 patient days and 15 during 108 320 patient days in two subsequent study periods, respectively (p<0.00 1). CONCLUSIONS: Prospective surveillance of computer-based medical records for known drug allergies and appropriate drug administration rates can reduce the number of type B ADEs. Early ADE detection and notification of physicians permit drug and dosage changes that reduce the progression of mild and moderate ADEs to more severe conditions.

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.

scholarly journals Evaluation of a Commercial Multiplex Molecular Panel for Diagnosis of Infectious Meningitis and Encephalitis

2018 ◽  
Vol 56 (4) ◽  
pp. e01927-17 ◽  
Author(s):  
Rachael M. Liesman ◽  
Angela P. Strasburg ◽  
Angela K. Heitman ◽  
Elitza S. Theel ◽  
Robin Patel ◽  
...  
Keyword(s):  
Bacterial Culture ◽  
Salt Lake ◽  
Salt Lake City ◽  
Bacterial Pathogen ◽  
Central Nervous System Infections ◽  
Pcr Assay ◽  
Content Type ◽  
Lake City ◽  
Antigen Testing ◽  
Positive Agreement

ABSTRACT Rapid and accurate laboratory tests are important for the timely diagnosis and treatment of central nervous system infections. The FilmArray meningitis/encephalitis (ME) panel (BioFire Diagnostics, Salt Lake City, UT) is an FDA-cleared, multiplex molecular panel that allows the detection of 14 pathogens (bacterial [n = 6], viral [n = 7], and fungal [n = 1] pathogens) from cerebrospinal fluid (CSF). In this study, we evaluated the performance characteristics of the FilmArray ME panel using clinical, residual CSF samples (n = 291) that tested positive by a routine method(s) (e.g., bacterial culture, individual real-time PCR assay) for a pathogen represented on the ME panel. Of note, a subset (n = 76) of the CSF specimens was collected during the prevaccine era and had been characterized as positive for a bacterial pathogen. The FilmArray ME panel demonstrated an overall percent positive agreement (PPA) of 97.5% (78/80) for bacterial pathogens, 90.1% (145/161) for viruses, and 52% (26/50) for Cryptococcus neoformans/C. gattii. Despite the low overall agreement (52%) between the ME panel and antigen testing for detection of C. neoformans/C. gattii, the percent positive agreement of the FilmArray assay for C. neoformans/C. gattii was 92.3% (12/13) when the results were compared directly to the results of routine fungal smear or culture. The FilmArray ME panel offers a rapid (∼60-min), syndrome-based approach for the detection of select meningitis and encephalitis 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 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.

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