1759. High Proportion of Discordant Results in Culture-Independent Diagnostic Tests (CIDT) for Shiga Toxin, Foodborne Disease Active Surveillance Network (FoodNet), 2012−2017
Session: Oral Abstract Session: Diagnostics Making a Difference
Saturday, October 6, 2018: 11:15 AM
Room: S 158
Background: FoodNet conducts active laboratory-based surveillance for nine pathogens transmitted commonly through food, including Shiga toxin-producing E. coli (STEC). Adoption of CIDTs has allowed for rapid identification of Shiga toxin or Shiga toxin genes, but incorporating multiple test results with differing sensitivity and specificity complicates treatment decisions and public health surveillance. Between 2007 and 2017, FoodNet reported increases in the use of CIDTs and decreases in rates of confirmation by culture.

Methods: We examined STEC cases reported to FoodNet during 20122017 with a positive immunoassay (IA) or polymerase chain reaction (PCR) test performed at a clinical laboratory, followed by positive or negative test at a state public health laboratory. Three test type combinations were assessed (IA/IA, PCR/PCR, and IA/PCR) by state, symptoms, test discordance, and culture (cx) result.

Results: During 20122017, 8,298 (76% of all STEC reported) specimens were tested by IA or PCR at both a clinical and a public health laboratory, 58% by IA/PCR, 27% by IA/IA, and 25% by PCR/PCR; some specimens had more than one test at each laboratory. Among these, 8,132 (98%) were also tested by cx. Among the IA/PCR test results, 20% were discordant and 75% of these were cx-negative. Even more of IA/IA (27%) and PCR/PCR (24%) results were discordant, and 75% of these were cx-negative. A median of 24% of test results were discordant (range by state, 13%–44%). Persons with discordant test results were less likely to have diarrhea (91% vs 97%) and bloody diarrhea (33% vs 57%). During 2012–2017, discordant results increased for IA/PCR (14% to 22%), IA/IA (17% to 34%), and PCR/PCR (6% to 25%). Most (85%) specimens with discordant results were cx-negative and 8% did not have a cx.

Conclusion: Almost a quarter of results were discordant, with marked variation by state, and most of these infections could not be confirmed by culture at the public health laboratory. Discordant results can pose problems for patient management. Including or excluding patients with discordant results also affects our ability to measure trends. Sensitivity and specificity of test types, test targets, and specimen transport must be considered when interpreting test results.

Kelly A. Barrett, MPH, National Center for Emerging and Zoonotic Infectious Diseases, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, Danielle Tack, DVM, MPVM, DACVPM, Centers for Disease Control and Prevention, Atlanta, GA, Carlota Medus, PhD, MPH, Minnesota Dept Health, St. Paul, MN, Katie N. Garman, M.P.H., C.H.E.S., Tennessee Department of Health, Nashville, TN, John Dunn, DVM, PhD, Division of Communicable and Environmental Diseases and Emergency Preparedness, Tennessee Department of Health, Nashville, TN, Sharon Hurd, MPH, CT EIP, New Haven, CT, Julie Hatch, MT, OR Dept of Human Services, Portland, OR, Karleys Parada, MPH, Georgia Emerging Infections Program, Atlanta, GA, Siri Wilson, MPH, Georgia Department of Public Health, Atlanta, GA, Elisha Wilson, MPH, Colorado Department of Public Health and Environmental, Denver, CO, Kathryn Wymore, MPH, California Emerging Infections Program, Oakland, CA, Patricia M. Griffin, MD, FIDSA, Division of Foodborne, Waterborne, and Environmental Diseases, CDC, Atlanta, GA and Aimee L. Geissler, PhD, MPH, National Center for Emerging Zoonotic Infectious Diseases, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA

Disclosures:

K. A. Barrett, None

D. Tack, None

C. Medus, None

K. N. Garman, None

J. Dunn, None

S. Hurd, None

J. Hatch, None

K. Parada, None

S. Wilson, None

E. Wilson, None

K. Wymore, None

P. M. Griffin, None

A. L. Geissler, None

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