213. Impact of a Stool Multiplex PCR Rapid Diagnostic Test on Antibiotic Prescribing in Patients Hospitalized with Diarrhea of Suspected Infectious Etiology
Session: Poster Abstract Session: Diagnostics: Enteric Infection
Thursday, October 27, 2016
Room: Poster Hall
Posters
  • 213_IDWPOSTER_Shihadeh.pdf (429.9 kB)
  • Background:

    Rapid diagnostic tests are being increasingly utilized in clinical practice, but their impact on clinical care has not been adequately described. In December 2014, the FilmArray® Gastrointestinal (GI) Panel (Stool PCR) was implemented at Denver Health. This panel tests for 22 common pathogens including bacteria, viruses, and parasites. The purpose of this study is to evaluate the diagnostic yield of the Stool PCR and its effect on antimicrobial management in patients hospitalized with diarrhea of suspected infectious etiology.

    Methods:

    This is a retrospective cohort study. All inpatients who had Stool PCR ordered between December 2014 and February 2016 were identified from our hospital data warehouse. We performed manual chart review of each case where the Stool PCR detected a pathogen to determine clinical management. The primary outcome of interest was the frequency of initiation, change, or discontinuation of antimicrobial therapy based on the Stool PCR result.

    Results:

    Stool PCR was ordered 433 times on 291 unique inpatients. Of the tests ordered, 221 (51%) were performed. In the majority of cases where the test was not performed, a specimen was not received by lab. Of the 221 Stool PCR tests performed, a pathogen was detected in 94 (43%). The most common pathogens were Clostridium difficile (51, 54%), Norovirus (14, 15%), and Enteropathogenic E. coli (13, 14%). In the 94 cases where a pathogen was identified, clinical management was changed in 73 (78%) patients, including the initiation or modification of antibiotics in 47 (50%) patients and the discontinuation of antibiotic therapy in 26 (28%) patients. Of the 47 patients who had antibiotics initiated or modified, 30 (32%) patients had a pathogen other than Clostridium difficile detected by Stool PCR.

    Conclusion:

    In hospitalized patients, the use of a multiplex stool PCR diagnostic test led to a change in antibiotic prescribing in 17% of cases in which it was ordered and 78% of cases in which a pathogen was identified. Additional analysis to evaluate appropriateness of antimicrobial prescribing based on Stool PCR results is underway.

    Figure 1.

     

    Kati Shihadeh, PharmD, Acute Care Pharmacy, Denver Health Medical Center, Denver, CO, Heather Young, MD, Infectious Diseases, Denver Health Medical Center, Denver, CO, Bryan Knepper, MPH, MSc, CIC, Patient Safety and Quality, Denver Health Medical Center, Denver, CO and Timothy Jenkins, MD, Medicine/Infectious Diseases, University of Colorado-Denver Health Sciences Center, Denver, CO

    Disclosures:

    K. Shihadeh, None

    H. Young, None

    B. Knepper, None

    T. Jenkins, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.