Jordan E Axelrad1, Andrew Joelson1, Yael Nobel1, Susan Whittier2, Garrett Lawlor1, Mark S Riddle3, Peter H R Green1, Benjamin Lebwohl4. 1. Division of Digestive and Liver Disease, Department of Medicine, Columbia University Medical Center, 180 Fort Washington Avenue, Suite 936, New York, NY, 10032, USA. 2. Department of Microbiology, Columbia University Medical Center, New York, NY, USA. 3. Department of Preventive Medicine and Biostatistics, Uniformed Services University, Bethesda, MD, USA. 4. Division of Digestive and Liver Disease, Department of Medicine, Columbia University Medical Center, 180 Fort Washington Avenue, Suite 936, New York, NY, 10032, USA. BL114@columbia.edu.
Abstract
BACKGROUND: Gastrointestinal infection is a major cause of morbidity. We sought to characterize the pathogenic etiologies of gastrointestinal infection to identify seasonal patterns and predictors of specific infections utilizing a multiplex PCR assay in clinical practice. METHODS: We performed a cross-sectional study of 9403 patients who underwent 13,231 stool tests with a FilmArray gastrointestinal pathogen PCR panel during an episode of diarrhea from March 2015 to May 2017. Our primary outcome was the presence of a positive panel. Logistic regression was used to test for associations between season and infections. RESULTS: A positive result was found in 3426 tests (25.9%) in 2988 patients (31.8%), yielding 4667 pathogens consisting of 1469 viruses (31.5%), 2925 bacteria (62.7%), and 273 parasites (5.8%). Age less than 50 years was associated with a higher prevalence of pathogens compared to age ≥ 50 (p < 0.0001). The overall prevalence of a positive result for bacteria peaked in the summer (635, 29.2%), and the prevalence of viruses peaked in the winter (446, 31.8%). Compared to the winter, testing in the summer yielded a higher prevalence of bacteria (OR 1.52, 95% CI 1.33, 1.73, p < 0.0001) and lower odds of viruses (OR 0.69, 95% CI 0.58, 0.81, p < 0.0001), primarily driven by E. coli species and norovirus. CONCLUSIONS: Season was a major determinant in detecting specific pathogens. Our substantially lower positivity rate than previous reports in the literature on multiplex PCR assays may more accurately reflect true clinical practice. Recognizing the temporal distribution of enteric pathogens may help facilitate empiric treatment decisions in certain clinical situations.
BACKGROUND: Gastrointestinal infection is a major cause of morbidity. We sought to characterize the pathogenic etiologies of gastrointestinal infection to identify seasonal patterns and predictors of specific infections utilizing a multiplex PCR assay in clinical practice. METHODS: We performed a cross-sectional study of 9403 patients who underwent 13,231 stool tests with a FilmArray gastrointestinal pathogen PCR panel during an episode of diarrhea from March 2015 to May 2017. Our primary outcome was the presence of a positive panel. Logistic regression was used to test for associations between season and infections. RESULTS: A positive result was found in 3426 tests (25.9%) in 2988 patients (31.8%), yielding 4667 pathogens consisting of 1469 viruses (31.5%), 2925 bacteria (62.7%), and 273 parasites (5.8%). Age less than 50 years was associated with a higher prevalence of pathogens compared to age ≥ 50 (p < 0.0001). The overall prevalence of a positive result for bacteria peaked in the summer (635, 29.2%), and the prevalence of viruses peaked in the winter (446, 31.8%). Compared to the winter, testing in the summer yielded a higher prevalence of bacteria (OR 1.52, 95% CI 1.33, 1.73, p < 0.0001) and lower odds of viruses (OR 0.69, 95% CI 0.58, 0.81, p < 0.0001), primarily driven by E. coli species and norovirus. CONCLUSIONS: Season was a major determinant in detecting specific pathogens. Our substantially lower positivity rate than previous reports in the literature on multiplex PCR assays may more accurately reflect true clinical practice. Recognizing the temporal distribution of enteric pathogens may help facilitate empiric treatment decisions in certain clinical situations.
Authors: Sarah N Buss; Amy Leber; Kimberle Chapin; Paul D Fey; Matthew J Bankowski; Matthew K Jones; Margarita Rogatcheva; Kristen J Kanack; Kevin M Bourzac Journal: J Clin Microbiol Date: 2015-01-14 Impact factor: 5.948
Authors: J D Greig; P Michel; J B Wilson; A M Lammerding; S E Majowicz; J Stratton; J J Aramini; R K Meyers; D Middleton; S A McEwen Journal: Can J Public Health Date: 2001 Sep-Oct
Authors: Jordan E Axelrad; Daniel E Freedberg; Susan Whittier; William Greendyke; Benjamin Lebwohl; Daniel A Green Journal: J Clin Microbiol Date: 2019-02-27 Impact factor: 5.948
Authors: Jordan E Axelrad; Benjamin Lebwohl; Edward Cuaresma; Ken Cadwell; Peter H R Green; Daniel E Freedberg Journal: Gut Pathog Date: 2018-07-09 Impact factor: 4.181