rate of detection of multiple organisms and clostridium
TRANSCRIPT
Lehigh Valley Health NetworkLVHN Scholarly Works
Department of Pediatrics
Rate of Detection of Multiple Organisms andClostridium difficile with Stool Multiplex PCRDetection Test in Pediatrics (Poster).Saisho Mangla DOLehigh Valley Health Network, [email protected]
Tibisay Villalobos MDLehigh Valley Health Network, [email protected]
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Published In/Presented AtMangla, S. Villalobos, T. (2017, October 4). Rate of Detection of Multiple Organisms and Clostridium difficile with Stool Multiplex PCRDetection Test in Pediatrics. Poster Presented at: IDweek 2017, San Diego, California.
References:1. Buss SN, Leber A, Chapin K, et al. Multicenter evaluation of the BioFire FilmArray
gastrointestinal panel for etiologic diagnosis of infectious gastroenteritis. J Clin Microbiol. 2015 Mar; 53(3):915-25.
2. Spina A, Kerr KG, Cormican M, et al. Spectrum of enteropathogens detected by the FilmArray GI Panel in a multicentre study of community-acquired gastroenteritis. Clin Microbiol Infect. 2015 Aug; 21(8):719-28.
© 2017 Lehigh Valley Health Network
Rate of Detection of Multiple Organisms and Clostridium difficile with Stool Multiplex CPR Detection Test in Pediatrics
New multiplex molecular assays have been developed to determine the etiology of infectious gastroenteritis. Unfortunately, these assays can detect multiple organisms simultaneously along with Clostridium difficile (C.diff), making it difficult to differentiate true pathogen versus colonization.
In January 2015, our institution switched from traditional testing methods to a multiplex polymerase chain reaction (PCR) detection test (FilmArrayTM Gastrointestinal Panel. BioFireDX, Salt Lake City, Utah). The objective of our study was to determine the number of FilmArrayTM panels that detected C.diff and/or multiple organisms.
• Although the FilmArrayTM Gastrointestinal Panel is a useful single modality for determining the etiology of infectious gastroenteritis, more than one organism is frequently detected.
• C.diff has become the most common organism isolated among children at our institution.
• Caution should be used when interpreting the isolation of C.diff in younger children and when isolated with other organisms since it is likely to be a colonizer.
Distribution of Organisms by Multiplex PCR in 2016
Figure 2: A total of 294 organisms were detected collectively in all of the positive FilmArrayTM panels. C. difficile was the most commonly isolated organism.
27
2014
105
8
37
3 2
85
4 4
41
6
16
36
2 3 3
0
20
40
60
80
100
120
Num
ber o
f Tim
es D
etec
ted
70
3332
2825
23 2220
9 96 6 5
2 1 1 1 10
10
20
30
40
50
60
70
80N
umbe
r of T
imes
Det
ecte
d
Organism
STUDY OBJECTIVES:• Determine the distribution of organisms detected by the FilmArrayTM
panel.
METHODS:• Retrospective data review of FilmArrayTM panels in pediatric patients
18 years and younger from January 2015 to December 2016.
• Stool samples were received from both inpatient and outpatient setting.
EXCLUSION CRITERIA:• Any patient older than 18 years.
Figure 1: A total of 416 organisms were detected collectively in all of the positive FilmArrayTM panels. C. difficile was the most commonly isolated organism.
Distribution of Organisms by Multiplex PCR in 2015
Age Distribution of All C.diff Isolated in 2016
9
25
10
87
5
2
11
3 34
5
2 2
5
1
3
0
5
10
15
20
25
30
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Num
ber o
f Film
Arra
y Pa
nels
Age
Figure 3: The age distribution of patient with C.difficile isolated on FilmArrayTM
panels in 2016.
Age Distribution of All C.diff Isolated in 2015
Figure 4: The age distribution of patient with C.difficile isolated on FilmArrayTM
panels in 2015.
4
18
9
5
3
1
4 4
2 2
4
2
1
2
3
2 2 2
0
2
4
6
8
10
12
14
16
18
20
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Num
ber o
f Film
Arra
y Pa
nels
Age
0
2
4
6
8
10
12
14
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Num
ber o
f Film
Arra
y Pa
nels
AgeC.Diff Isolated Alone C.Diff Isolated with another organism C.Diff isolated with two organisms C.diff isolated with 3 organisms
Age Distribution of Panels with C.diff Isolated in 2016
Figure 7: The age distribution of patient with C.difficile isolated on FilmArrayTM panels.
Organisms Isolated with C.diff in 2016
Figure 5: The distribution of organisms that were detected in combination with C.difficile.
2
6
0
2
7
0 0
14
1
0
6
3 3
4
0 0
2
0
2
4
6
8
10
12
14
16
Organisms Isolated with C.diff in 2015
Figure 6: The distribution of organisms that were detected in combination with C.difficile.
3. Stockmann C, Rogatcheva M, Harrel B, et al. How well does physician selection of microbiologic tests identify Clostridium difficile and other pathogens in paediatric diarrhoea? Insights using multiplex PCR-based detection. Clin Microbiol Infect. 2015 Feb; 21(2):179.e9-15.
4. Zhang H, Morrison S, Tang YW. Multiplex polymerase chain reaction tests for detection of pathogens associated with gastroenteritis. Clin Lab Med. 2015 Jun; 35(2):461-86.
Lehigh Valley Health Network, Allentown, Pennsylvania
Saisho Mangla, DO and Tibisay Villalobos, MD, FAAP
6
1 1
8
1
14
11
1 1 1 1 1
0
2
4
6
8
10
12
14
16
Sapo
virus
(I, II
, IV an
d V)
Noro
virus
GI/G
II
Astro
virus
Aden
oviru
s F 40
/41
Rotav
irus A
Enter
oagg
rega
tive E
. coli
(EAE
C)
Enter
opath
ogen
ic E.
coli (
EPEC
)
Shiga
-like t
oxin-
prod
ucing
E. c
oli (S
TEC)
Salm
onell
a
Yersi
nia en
teroc
olitic
a
Camp
yloba
cter (
jejun
i, coli
and u
psali
ensis
Cryp
tospo
ridium
CONCLUSIONS
RESULTSBACKGROUND
Table 1. Twenty Two Potential Organisms that can be Detected by the FilmArrayTM Gastrointestinal Panel
Bacteria Diarrheagenic E. coli/Shigella Parasites Viruses
Campylobacter (jejuni, coli and upsaliensis) Enteroaggregative E. coli (EAEC) Cryptosporidium Adenovirus F 40/41
Clostridium difficile (toxin A/B) Enteropathogenic E. coli (EPEC) Cyclospora cayetanensis Astrovirus
Plesiomonas shigelloides Enterotoxigenic E. coli (ETEC) lt/st Entamoeba histolytica Norovirus GI/GII
Salmonella Shiga-like toxin-producing E. coli (STEC) stx1/stx2 Giardia lamblia Rotavirus A
Yersinia enterocolitica E. coli O157 Sapovirus (I, II, IV and V) Vibrio (parahaemolyticus, vulnificus and cholerae) Shigella/Enteroinvasive E. coli (EIEC)
Vibrio cholerae