Methods: Retrospective cohort study of children ≤ 18 years with IBD evaluated at Nationwide Children’s Hospital who presented with gastrointestinal complaints and in whom the primary gastroenterologist ordered a stool culture. A convenience sampling of stool specimens was also tested using the FilmArray GI Panel from May 1- September 30, 2013; results were not reported. Medical record review was performed on evaluable patients. The primary objective was to compare the diagnostic yield of CT versus FilmArray GI panel.
Results: Sixty one patients (32 males; Crohn disease in n=35, Ulcerative Colitis n=23, and indeterminate colitis n=3) presented to an outpatient clinic with worsening diarrhea or bloody stools and submitted 69 stool specimens for infectious testing by CT. Sixteen (25%) IBD patients had + CT results and concomitant detection by FilmArray GI including C. difficile (n=15), Plesiomonas spp (n=1), and Salmonella spp (n=1). Median time to final CT results was 3 days [range 0-13]. One patient had Edwardsiella spp detected by CT. In 4 patients with +CT, the FilmArray GI also detected enteropathogenic E. coli (EPEC, n=2), enteroaggregative E.coli (EAEC, n=1), and norovirus (n=1). The FilmArray GI detected additional potential pathogens in another 11 (18%) patients with negative CT results including: C. difficile (n=1), norovirus (n=1), and enteropathogenic E. coli (EPEC, n=9). One patient with negative C. difficile results by CT may have required antimicrobial therapy. Four patients with negative results by CT had additional testing performed because of continued symptoms including colonoscopy (n=2) and abdominal imaging (n=2).
Conclusion: In symptomatic IBD patients, application of the FilmArray GI panel may allow for timely and sensitive diagnostic results that aid in patient management. Further data are needed to ascertain the significance of detection of EPEC, EAEC, and co-detections in this population.
M. I. Ardura,
A. Leber, BioFire Diagnostics: Collaborator , Consulting fee