1182. Appropriateness of a Rapid Multiplex Gastrointestinal Panel in the Investigation of Suspected Infectious Diarrhea After Implementation at an Academic Medical Center
Session: Poster Abstract Session: Enteric Infections and Diagnostics
Friday, October 6, 2017
Room: Poster Hall CD
Posters
  • Beatty IDSA 2017 GI panel appropriateness FINAL.pdf (364.8 kB)
  • Background: The BioFire FilmArray™ Gastrointestinal (GI) Panel is a one hour multiplex real-time PCR test that can detect the presence of 22 GI pathogens (viral, bacterial, and parasitic) known to cause infectious diarrhea. Our tertiary-care academic medical center implemented the GI Panel for all cases of suspected infectious diarrhea replacing the previous conventional testing once utilized to detect GI pathogens. Since its implementation we have not had any criteria for ordering this test to aid healthcare providers.

    Methods: The aim of this IRB approved, retrospective investigation was to determine the appropriateness of ordering the GI panel at our academic institution. Cases were randomly selected, stratified by age group and result (specific pathogens or negative result) from May 2015 through April 2016 in the post-implementation period (n=400 of 1117 total tests). We developed appropriateness criteria for ordering the GI panel which included: passage of at least 3 unformed stools in 24 hours plus one or more enteric symptom (nausea, vomiting, abdominal pain/cramps, tenesmus, fecal urgency, moderate to severe flatulence), and one of the following: grossly bloody diarrhea (dysenteric), persistent diarrhea (14 – 30 days), worsening or relapsing diarrhea, fever ≥ 101 F°, severe diarrhea > 10 bouts in 24hrs, immunosuppression, pregnancy, food handler, infant < 1 year and their care takers, age ≥ 65 years old, concern for disseminated GI infection, with no previous GI panel testing in the past 30 days.

    Results: Overall appropriateness of GI panel testing based off our generated criteria was 36% (n=144/400). This included all tests ordered in the outpatient clinics, emergency department, inpatient medical/surgical wards, and intensive care units.

    Conclusion: Currently there is not a well-established standard criteria for ordering the GI panel for investigating suspected infectious diarrhea. After implementation at our academic tertiary-care medical center the GI panel was used inappropriately in most cases without a criteria for ordering in place to aid clinicians. Educating healthcare providers about appropriate testing indications is being performed. Further studies are needed to assess if our generated criteria will lead to decreased costs and unnecessary testing.

    Norman Beatty, MD1, David Nix, PharmD2, Jessica August, MD1, Roberto Swazo, MD1, Janame Kottey, MD1, Kyle Mckeown, MPH3, Mohannad Alshibani, PharmD2,4, Wanda Petty, BS5, Kathryn Matthias, PharmD2 and Mayar Al Mohajer, MD, MBA, CAQ, FACP6, (1)Internal Medicine, University of Arizona College of Medicine at South Campus, Tucson, AZ, (2)Department of Pharmacy Practice and Science, University of Arizona College of Pharmacy, Tucson, AZ, (3)University of Arizona College of Medicine, Tucson, AZ, (4)College of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia, (5)Department of Pathology, Banner University Medical Center, Tucson, AZ, (6)Department of Medicine, Division of Infectious Diseases, Baylor College of Medicine, Houston, TX

    Disclosures:

    N. Beatty, None

    D. Nix, None

    J. August, None

    R. Swazo, None

    J. Kottey, None

    K. Mckeown, None

    M. Alshibani, None

    W. Petty, None

    K. Matthias, None

    M. Al Mohajer, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 4th with the exception of research findings presented at the IDWeek press conferences.