Rapid multiplex gastrointestinal panel drives reduction in pediatric emergency department antibiotics

Testing pediatric emergency department (ED) patients with a rapid multiplex panel for gastrointestinal diseases decreased use of broad-spectrum antibiotics, additional visits, and admissions, while improving outcomes, researchers report from The Catholic University of Seoul in Korea (Ann Clin Microbiol Antimicrob 2024; doi: 10.1186/s12941-023-00662-3).

Acute diarrhea is common in infants and children. But conventional test methods can be difficult to use in the ED for multiple reasons, including slow turnaround time or low sensitivity. It’s a key reason why researchers have been eager to find ways to identify causative organisms early in the disease course. Pinpointing the culprit enables clinicians to quickly tailor treatment decisions, from isolation and transmission prevention measures to duration of hydration to administering antimicrobial therapy.

The research team in Seoul approached their study of rapid syndromic diagnostic testing for gastrointestinal pathogens as an ED pediatric clinical decision support tool. They compared clinical decision and patient outcome parameters before and after implementing the Biofire Film Array GI Panel, which detected 22 pathogens.

The pathogens were Campylobacter (C. jejuni/C. coli/C. upsaliensis), Clostridioides (Clostridium) difficile (toxin A/B), Plesiomonas shigelloides, Salmonella, Yersinia enterocolitica, Bibrio (V. parahaemolyticus/V. vulnificus/V. cholerae), enteroaggregative E. coli, enteropathogenic E. coli, enterotoxigenic E. coli lt/st, shiga-like toxin-producing E. coli stx1/stx2, E. coli O157, shigella/enteroinvasive E. coli, Cryptosporidium, Cyclospora cayetanensis, Entamoeba histolytica, Giardia lamblia, adenovirus F40/41, astrovirus, aorovirus GI/GII, rotavirus A, and sapovirus (I, II, IV, and V).

The researchers assessed clinicians’ decisions to prescribe antibiotics by noting changes from before and after the panel’s implementation. They looked at the proportion of patients prescribed broad-spectrum antibiotics, duration of ED stay, the number of ED revisits within 7 days for the same episode of acute diarrhea, hospitalization rate from the outpatient clinic after discharge from the ED, and disease progression rate for patients that eventually were treated in the intensive care unit.

Their analysis included 4,184 patients from a Korean tertiary care academic hospital who were younger than 18 and visited the ED for acute diarrhea, with symptoms that began within the past 72 hours. Participants did not suffer from immunocompromised immune symptoms or chronic conditions, they noted.

Compared to the pre-implementation period, clinicians with access to the test panel prescribed broad spectrum antibiotics at a significantly lower rate for patients presenting with acute infectious diarrhea at discharge from the ED.

During the implementation period, 9.9% of patients presenting with acute infectious diarrhea were prescribed broad spectrum antibiotics at discharge, compared to 15.8% in the pre-implementation period. At admission, 52.2% of implementation period patients were prescribed antibiotics, compared to 66% during the pre-implementation period.

Another finding: the implementation period ED stay duration of 6.5 hours was significantly longer than the 5.5-hour pre-implementation period stay. However, the rate of return ED visits was significantly lower during the implementation period: After implementation, 2.6% of patients returned to the ED, versus 5.2% of patients before implementation.

The admission rate during follow-up after ED discharge was 0.8% during the implementation period, versus 2.1% in the pre-implementation period. The researchers saw no significant difference in disease progression among patients between these two periods.

The researchers underscored the importance of diagnostic stewardship as the context for the results of the study. “Our study confirmed that certain benefits exist in the utilization of syndromic multiplex GI panels in the ED setting, and with correct diagnostic stewardship, targeted patient groups can receive tailored intervention with treatment decisions that can improve the quality of medical care,” they wrote.