Children's Mercy Hospitals and Clinics, Kansas City, Missouri, USA.
University of Missouri, School of Medicine, Kansas City, Missouri, USA.
J Clin Microbiol. 2023 Mar 23;61(3):e0165222. doi: 10.1128/jcm.01652-22. Epub 2023 Feb 28.
Fecal culture for isolation and identification of may take days. The BioFire FilmArray Gastrointestinal (GI) panel (bioMérieux, France) is a PCR-based assay that detects enteric pathogens including /enteroinvasive Escherichia coli (EIEC) in about an hour. The aim of this study was to evaluate the impact of GI panel detection of in a pediatric emergency department (ED) during an outbreak. Stool samples from children with acute gastroenteritis were tested by the GI panel. Test results were either withheld in preintervention (PRE) or reported to clinicians/families in the postintervention (POST) period. The impact of the GI panel testing on patient management and outcomes was measured. EIEC was identified by the GI panel in the PRE ( = 30) and POST ( = 21) phase. The GI panel detected more infections than did culture; six of 31 (19.4%) GI panel-positive patients who also had stool cultures were missed by culture. Azithromycin therapy was prescribed for 20% of subjects in the PRE phase and 71.4% of subjects in the POST phase ( < 0.001). Time from the clinical encounter until starting azithromycin therapy was shorter in the POST phase ( = 9), 8.25 h (range, 6.37 to 52.37 h), than in the PRE phase ( = 1), 72 h. Six subjects in the PRE phase visited additional providers compared with one in the POST phase. Prompt diagnosis of shigellosis with the GI panel may provide the opportunity for prompt antimicrobial therapy and avoid additional visits to providers due to early definitive diagnosis. Prompt diagnosis of at an ED visit may optimize patient management and reduce transmission.
粪便培养以分离和鉴定志贺菌可能需要数天时间。生物梅里埃公司（法国）的 FilmArray 肠道（GI）panel 是一种基于 PCR 的检测方法，可在大约 1 小时内检测出肠道病原体，包括侵袭性大肠杆菌（EIEC）。本研究旨在评估在爆发期间儿科急诊部（ED）使用 GI panel 检测志贺菌对患者管理和结果的影响。对患有急性肠胃炎的儿童粪便样本进行 GI panel 检测。在干预前（PRE）阶段，检测结果被保留，或在干预后（POST）阶段报告给临床医生/家属。测量 GI panel 检测对患者管理和结果的影响。在 PRE（ = 30）和 POST（ = 21）阶段，GI panel 鉴定出 EIEC。GI panel 检测到的感染病例比培养多；31 例 GI panel 阳性且粪便培养也阳性的患者中有 6 例被培养漏诊。在 PRE 阶段，20%的患者接受了阿奇霉素治疗，而在 POST 阶段，71.4%的患者接受了阿奇霉素治疗（ < 0.001）。在 POST 阶段（ = 9），从临床接触到开始阿奇霉素治疗的时间更短，为 8.25 小时（范围，6.37 至 52.37 小时），而在 PRE 阶段（ = 1）为 72 小时。在 PRE 阶段，有 6 例患者看了其他医生，而在 POST 阶段只有 1 例。通过 GI panel 快速诊断志贺菌病可以提供及时进行抗菌治疗的机会，并避免因早期明确诊断而额外就诊。在 ED 就诊时快速诊断志贺菌可能会优化患者管理并减少传播。
