Background: The BIOFIRE® Gastrointestinal (GI) Panel is a multiplex molecular assay allowing simultaneous detection of 22 pathogens in 1 hour (13 bacteria, 5 virus and 4 parasites). The objective was to assess the impact of the results of the GI Panel on the clinical management of children with acute diarrhea consulting in a pediatric emergency department of a tertiary care center.
Materials/methods: All children admitted in the pediatric emergency department of Robert-Debré, universitary hospital, Paris France, from May to October 2019, for an acute diarrhea with medical indication for stool culture were included in this prospective monocentric study. Indications for stool culture followed European guidelines. A GI Panel PCR was performed on each stool sample. Data on children initial care and on changes in their medical management following GI Panel results were collected.
Results: 176 children were included. The median age was 1 year and 10 months old, IQR (6 months; 6 years old). The main indications for stool culture were bloody diarrhea and/or traveler’s diarrhea (74% of cases). The GI Panel was positive in 70% of cases. Entero-aggregative Escherichia coli (22%), enteropathogenic E. coli (20%), Shigella/ enteroinvasive E. coli (15%) and Campylobacter (12%) were the most commonly detected pathogens. GI Panel compared to stool culture detected respectively 21 versus 19 Campylobacter, 12 versus 10 Salmonella and 27 versus 13 Shigella/ enteroinvasive E. coli. Results of the GI Panel resulted in a change of medical care for 60 patients (34%) before stool culture results (28 initiations, 4 changes and 1 discontinuation of antibiotic therapy; 2 hospitalizations; 4 specific Clostridium difficile isolations; 36 decisions to call parents by phone; 7 additional test prescriptions and 3 test cancellations). The most prescribed antibiotic following the GI Panel results was azithromycin (22 cases) for Shigella/ enteroinvasive E. coli (n=11), Campylobacter (n=6) and Shigatoxin- producing E. coli (n=5) infections. A cost analysis was carried out.
Conclusions: The GI Panel has a significant impact on the prescription of antibiotics before the results of stool culture in children with bacterial suspected acute diarrhea. Further studies are needed to better assess the cost-effectiveness of this assay.