Acute diarrhea is most commonly related to infectious etiology. Currently, available stool studies requires several testing methods to check for these infectious agents which can be associated with diagnosis delay, increase length of stay (LOS) and inappropriate use of antibiotics.
Retrospective chart review of 118 patients with acute diarrhea admitted to a tertiary medical center from 1/2015-5/2015. In addition to conventional stool studies including stool cultures, viral PCR and stool for ova and parasite, all stool samples were tested by TEM-PCR GI panel which include 3 viral, 7 bacterial and 2 protozoan targets
Patients mean age was 54 years old (1-94). 62 % were females. Pertinent positive history included recent antibiotic use in 42%, recent hospitalization 33%, Proton pump inhibitor (PPI) use 30%. PCR test was positive in 28 % of patients of which 12 % had recent antibiotics use and 12% were on PPI. Of the PCR negative patients 53 % reported recent antibiotic use and 36% were on a PPI. Stool cultures were done in 50% of patients with 42% positive mainly for gram positive organisms and yeast, Viral PCR 8% and stool for ova and parasite 43%. By TEM-PCR, most commonly detected targets were Rotavirus 36%, Norovirus 33%, EPEC 18%, Shigella and Enteroinvasive E. coli 9%, Campylobacter jejuni 9% and Adenovirus 3%. Detection of more than one target was seen in 9%, of which 67% had Norovirus with Enteropathogenic Escherichia coli (EPEC) and 33% had Rotavirus with Shigella. Norovirus and EPEC were detected more in female while Rotavirus and Shigella detected more in males. 13 % patients received antibiotics on admission for diarrheal symptoms leading to 116 cumulative days of inappropriate antibiotic use. Most common antimicrobials prescribed were Metronidazole and Levofloxacin. Delay in early identification of Norovirus and Rotavirus infection by conventional studies resulted in a cumulative 32 extra days of hospitalization.
Use of TEM-PCR to detect common causative agent's target of acute diarrhea might help to reduce multiple stool testing, LOS, inappropriate antibiotic use and cost. Further studies needed to evaluate the benefit of using this molecular testing in patients with acute diarrhea.
A. Hassoun, None