Murphy C N, Fowler R C, Iwen P C, Fey P D
Department of Pathology and Microbiology, University of Nebraska Medical Center, 985900 Nebraska Medical Center, Omaha, NE, 68198-5900, USA.
Nebraska Public Health Laboratory, University of Nebraska Medical Center, Omaha, NE, 68198-5900, USA.
Eur J Clin Microbiol Infect Dis. 2017 Apr;36(4):747-754. doi: 10.1007/s10096-016-2858-7. Epub 2016 Dec 12.
The BioFire FilmArray® Gastrointestinal Panel (GIP) was implemented to replace traditional stool culture and enzyme immunoassay (EIA) testing for stool pathogens. The purpose of this study was to evaluate the detection rate, incidence of coinfection, and culture recovery rate of gastrointestinal (GI) pathogens detected by the GIP over a 1-year period. A total of 2257 stools collected from January to December 2015 were tested using the GIP. Clostridium difficile colonization was also evaluated by an antigen/toxin EIA and confirmatory polymerase chain reaction (PCR). The GIP detected one pathogen in 911 (40.4%) specimens. Coinfections were detected in 176 (7.8%) of these specimens. The most frequently detected pathogens were C. difficile (15.2%), norovirus (8.9%), enteropathogenic Escherichia coli (7.1%), enteroaggregative E. coli (3.4%), Campylobacter spp. (2.3%), and sapovirus (2.0%). Each of the remaining GIP targets had a detection rate of ≤1.6%. The recovery of bacteria for public health investigations varied, with rates as high as 77% for Salmonella to as low as 30% for Yersinia enterocolitica. Of stools positive for C. difficile on the GIP that were tested by EIA, only 42.7% (88/206) were found to be producing detectable toxin. Overall, the implementation of the GIP resulted in high detection rates of GI pathogens, including the frequent detection of coinfections. This is a promising test to streamline the testing of agents causing infectious gastroenteritis from multiple tests down to a single order with limited hands-on time. Ongoing studies will need to assess the impact that the GIP has on downstream patient care and public health practices.
实施BioFire FilmArray®胃肠道检测板（GIP）以取代传统的粪便培养和粪便病原体酶免疫分析（EIA）检测。本研究的目的是评估GIP在1年期间检测到的胃肠道（GI）病原体的检出率、合并感染发生率和培养回收率。使用GIP对2015年1月至12月收集的总共2257份粪便进行检测。还通过抗原/毒素EIA和验证性聚合酶链反应（PCR）评估艰难梭菌定植情况。GIP在911份（40.4%）标本中检测到一种病原体。在这些标本中有176份（7.8%）检测到合并感染。最常检测到的病原体是艰难梭菌（15.2%）、诺如病毒（8.9%）、致病性大肠杆菌（7.1%）、聚集性大肠杆菌（3.4%）、弯曲杆菌属（2.3%）和札幌病毒（2.0%）。其余每个GIP检测靶点的检出率均≤1.6%。用于公共卫生调查的细菌回收率各不相同，沙门氏菌的回收率高达77%，而小肠结肠炎耶尔森菌的回收率低至30%。在通过EIA检测的GIP上艰难梭菌呈阳性的粪便中，仅42.7%（88/206）被发现产生可检测到的毒素。总体而言，GIP的实施导致GI病原体的高检出率，包括频繁检测到合并感染。这是一项很有前景的检测方法，可将引起感染性胃肠炎病原体的检测从多项检测简化为单一检测指令，且实际操作时间有限。正在进行的研究需要评估GIP对下游患者护理和公共卫生实践的影响。
