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Evaluation of the BioFire FilmArray® GastrointestinalPanel in a Midwestern Academic Hospital

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Abstract

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.

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References

  1. Binnicker MJ (2015) Multiplex molecular panels for diagnosis of gastrointestinal infection: performance, result interpretation, and cost-effectiveness. J Clin Microbiol 53:3723–3728

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Buss SN, Leber A, Chapin K, Fey PD, Bankowski MJ, Jones MK, Rogatcheva M, Kanack KJ, Bourzac KM (2015) Multicenter evaluation of the BioFire FilmArray gastrointestinal panel for etiologic diagnosis of infectious gastroenteritis. J Clin Microbiol 53:915–925

    Article  PubMed  PubMed Central  Google Scholar 

  3. Buss SN, Alter R, Iwen PC, Fey PD (2013) Implications of culture-independent panel-based detection of Cyclospora cayetanensis. J Clin Microbiol 51:3909–3913

    Article  PubMed  PubMed Central  Google Scholar 

  4. Chitnis AS, Holzbauer SM, Belflower RM, Winston LG, Bamberg WM, Lyons C, Farley MM, Dumyati GK, Wilson LE, Beldavs ZG, Dunn JR, Gould LH, MacCannell DR, Gerding DN, McDonald LC, Lessa FC (2013) Epidemiology of community-associated Clostridium difficile infection, 2009 through 2011. JAMA Intern Med 173:1359–1367

    Article  PubMed  Google Scholar 

  5. Collins CE, Ayturk MD, Flahive JM, Emhoff TA, Anderson FA Jr, Santry HP (2014) Epidemiology and outcomes of community-acquired Clostridium difficile infections in Medicare beneficiaries. J Am Coll Surg 218:1141–1147.e1

    Article  PubMed  PubMed Central  Google Scholar 

  6. Fitzgerald C, Patrick M, Gonzalez A, Akin J, Polage CR, Wymore K, Gillim-Ross L, Xavier K, Sadlowski J, Monahan J, Hurd S, Dahlberg S, Jerris R, Watson R, Santovenia M, Mitchell D, Harrison C, Tobin-D’Angelo M, DeMartino M, Pentella M, Razeq J, Leonard C, Jung C, Achong-Bowe R, Evans Y, Jain D, Juni B, Leano F, Robinson T, Smith K, Gittelman RM, Garrigan C, Nachamkin I (2016) Multicenter evaluation of clinical diagnostic methods for detection and isolation of Campylobacter spp. from stool. J Clin Microbiol 54:1209–1215

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Furuya-Kanamori L, Stone JC, Clark J, McKenzie SJ, Yakob L, Paterson DL, Riley TV, Doi SA, Clements AC (2015) Comorbidities, exposure to medications, and the risk of community-acquired Clostridium difficile infection: a systematic review and meta-analysis. Infect Control Hosp Epidemiol 36:132–141

    Article  PubMed  Google Scholar 

  8. Goldenberg SD, Cliff PR, Smith S, Milner M, French GL (2010) Two-step glutamate dehydrogenase antigen real-time polymerase chain reaction assay for detection of toxigenic Clostridium difficile. J Hosp Infect 74:48–54

    Article  CAS  PubMed  Google Scholar 

  9. Halligan E, Edgeworth J, Bisnauthsing K, Bible J, Cliff P, Aarons E, Klein J, Patel A, Goldenberg S (2014) Multiplex molecular testing for management of infectious gastroenteritis in a hospital setting: a comparative diagnostic and clinical utility study. Clin Microbiol Infect 20:O460–O467

    Article  CAS  PubMed  Google Scholar 

  10. Hu J, Torres AG (2015) Enteropathogenic Escherichia coli: foe or innocent bystander? Clin Microbiol Infect 21:729–734

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Janda JM, Abbott SA (2014) Culture-independent diagnostic testing: have we opened Pandora’s box for good? Diagn Microbiol Infect Dis 80:171–176

    Article  PubMed  Google Scholar 

  12. Khare R, Espy MJ, Cebelinski E, Boxrud D, Sloan LM, Cunningham SA, Pritt BS, Patel R, Binnicker MJ (2014) Comparative evaluation of two commercial multiplex panels for detection of gastrointestinal pathogens by use of clinical stool specimens. J Clin Microbiol 52:3667–3673

    Article  PubMed  PubMed Central  Google Scholar 

  13. Lupp C, Robertson ML, Wickham ME, Sekirov I, Champion OL, Gaynor EC, Finlay BB (2007) Host-mediated inflammation disrupts the intestinal microbiota and promotes the overgrowth of Enterobacteriaceae. Cell Host Microbe 2:119–129

    Article  CAS  PubMed  Google Scholar 

  14. Murphy C, Fey P, Iwen P (2015) Aeromonas caviae as a common cause of gastroenteritis in patients receiving or awaiting liver or small bowel transplantation. In: Proceedings of the 115th General Meeting of the American Society for Microbiology, New Orleans, LA, May/June 2015, abstract 1962

  15. Planche TD, Davies KA, Coen PG, Finney JM, Monahan IM, Morris KA, O’Connor L, Oakley SJ, Pope CF, Wren MW, Shetty NP, Crook DW, Wilcox MH (2013) Differences in outcome according to Clostridium difficile testing method: a prospective multicentre diagnostic validation study of C difficile infection. Lancet Infect Dis 13:936–945

    Article  PubMed  PubMed Central  Google Scholar 

  16. Polage CR, Gyorke CE, Kennedy MA, Leslie JL, Chin DL, Wang S, Nguyen HH, Huang B, Tang YW, Lee LW, Kim K, Taylor S, Romano PS, Panacek EA, Goodell PB, Solnick JV, Cohen SH (2015) Overdiagnosis of Clostridium difficile infection in the molecular test era. JAMA Intern Med 175:1792–1801

    Article  PubMed  PubMed Central  Google Scholar 

  17. Prakash VP, LeBlanc L, Alexander-Scott NE, Skidmore J, Simmons D, Quilliam D, Chapin KC (2015) Use of a culture-independent gastrointestinal multiplex PCR panel during a Shigellosis outbreak: considerations for clinical laboratories and public health. J Clin Microbiol 53:1048–1049

    Article  PubMed  PubMed Central  Google Scholar 

  18. Qin X, Klein EJ, Galanakis E, Thomas AA, Stapp JR, Rich S, Buccat AM, Tarr PI (2015) Real-time PCR assay for detection and differentiation of shiga toxin-producing Escherichia coli from clinical samples. J Clin Microbiol 53:2148–2153

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Rand KH, Tremblay EE, Hoidal M, Fisher LB, Grau KR, Karst SM (2015) Multiplex gastrointestinal pathogen panels: implications for infection control. Diagn Microbiol Infect Dis 82:154–157

    Article  PubMed  Google Scholar 

  20. Scallan E, Hoekstra RM, Angulo FJ, Tauxe RV, Widdowson MA, Roy SL, Jones JL, Griffin PM (2011) Foodborne illness acquired in the United States—major pathogens. Emerg Infect Dis 17:7–15

    Article  PubMed  PubMed Central  Google Scholar 

  21. Schreckenberger PC, McAdam AJ (2015) Point-counterpoint: large multiplex PCR panels should be first-line tests for detection of respiratory and intestinal pathogens. J Clin Microbiol 53:3110–3115

    Article  PubMed  PubMed Central  Google Scholar 

  22. Smieja M, Goldfarb DM (2016) Molecular detection of diarrheal pathogens. Clin Microbiol Newsl 38:137–145

    Article  Google Scholar 

  23. Spina A, Kerr KG, Cormican M, Barbut F, Eigentler A, Zerva L, Tassios P, Popescu GA, Rafila A, Eerola E, Batista J, Maass M, Aschbacher R, Olsen KE, Allerberger F (2015) Spectrum of enteropathogens detected by the FilmArray GI Panel in a multicentre study of community-acquired gastroenteritis. Clin Microbiol Infect 21:719–728

    Article  CAS  PubMed  Google Scholar 

  24. Vallières E, Saint-Jean M, Rallu F (2013) Comparison of three different methods for detection of Shiga toxin-producing Escherichia coli in a tertiary pediatric care center. J Clin Microbiol 51:481–486

    Article  PubMed  PubMed Central  Google Scholar 

  25. Walker CLF, Rudan I, Liu L, Nair H, Theodoratou E, Bhutta ZA, O’Brien KL, Campbell H, Black RE (2013) Global burden of childhood pneumonia and diarrhoea. Lancet 381:1405–1416

    Google Scholar 

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Acknowledgements

Many thanks go to the Nebraska Medicine Clinical Microbiology Laboratory staff. Their efforts in the implementation of this test, subsequent follow-up cultures, and ongoing traditional testing was responsible for the generation of these data and, without them this work would not have been possible.

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Authors and Affiliations

  1. Department of Pathology and Microbiology, University of Nebraska Medical Center, 985900 Nebraska Medical Center, Omaha, NE, 68198-5900, USA

    C. N. Murphy, R. C. Fowler, P. C. Iwen & P. D. Fey

  2. Nebraska Public Health Laboratory, University of Nebraska Medical Center, Omaha, NE, 68198-5900, USA

    P. C. Iwen

Authors
  1. C. N. Murphy
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  2. R. C. Fowler
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  3. P. C. Iwen
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  4. P. D. Fey
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Correspondence to C. N. Murphy.

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Ethical approval and informed consent

For this implementation study, no formal consent was required.

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This research did not receive any specific grant from any funding agencies.

Conflict of interest

C.N.M. and P.D.F. have received research grants from BioFire Diagnostics, LLC. However, this company had no involvement in the study design, data analysis, or preparation of the manuscript. So we declare that there are no conflicts of interest for this submission.

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Murphy, C.N., Fowler, R.C., Iwen, P.C. et al. Evaluation of the BioFire FilmArray® GastrointestinalPanel in a Midwestern Academic Hospital. Eur J Clin Microbiol Infect Dis 36, 747–754 (2017). https://doi.org/10.1007/s10096-016-2858-7

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  • DOI: https://doi.org/10.1007/s10096-016-2858-7

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