Clinical impact of a gastrointestinal PCR panel in children with infectious diarrhoea.

Abstract

Multiplex gastrointestinal PCR (GI-PCR) allows fast and simultaneous detection of 22 enteric pathogens (including <i>Campylobacter, Salmonella</i>, <i>Shigella</i>/enteroinvasive <i>Escherichia coli (EIEC)</i>, among other bacteria, parasites and viruses). However, its impact on the management of children with infectious diarrhoea remains unknown. All children eligible for stool culture from May to October 2018 were prospectively included in a monocentric study at Robert-Debré University-Hospital. A GI-PCR (BioFire FilmArray) was performed on each stool sample. Data on the children's healthcare management before and after GI-PCR results were collected. Stool culture results were also reported. 172 children were included. The main criteria for performing stool analysis were mucous/bloody diarrhoea and/or traveller's diarrhoea (n=130). GI-PCR's were positive for 120 patients (70%). The main pathogens were enteroaggregative <i>E. coli</i> (n=39; 23%), enteropathogenic <i>E. coli</i> (n=34; 20%), <i>Shigella</i>/EIEC (n=27; 16%) and <i>Campylobacter</i> (n=21; 12%). Compared with stool cultures, GI-PCR enabled the detection of 21 vs 19 <i>Campylobacter,</i> 12 vs 10 <i>Salmonella,</i> 27 <i>Shigella/</i>EIEC vs 13 <i>Shigella</i>, 2 vs 2 <i>Yersinia enterocolitica</i>, 1 vs 1 <i>Plesiomonas shigelloides,</i> respectively. Considering the GI-PCR results and before stool culture results, the medical management was revised for 40 patients (23%): 28 initiations, 2 changes and 1 discontinuation of antibiotics, 1 hospitalisation, 2 specific room isolations related to <i>Clostridioides difficile</i> infections, 4 additional test prescriptions and 2 test cancellations. The GI-PCR's results impacted the medical management of gastroenteritis for almostone-fourth of the children, and especially the prescription of appropriate antibiotic treatment before stool culture results.