Waseem Ahmad1, Nghia H Nguyen1, Brigid S Boland2, Parambir S Dulai2, David T Pride3, Daniel Bouland4, William J Sandborn2, Siddharth Singh5,6. 1. Department of Internal Medicine, University of California San Diego, La Jolla, CA, USA. 2. Division of Gastroenterology, University of California San Diego, 9452 Medical Center Drive, ACTRI 1W501, La Jolla, CA, 92093, USA. 3. Department of Pathology and Infectious Diseases, University of California San Diego, La Jolla, CA, USA. 4. Division of Hospital Medicine, University of California San Diego, La Jolla, CA, USA. 5. Division of Gastroenterology, University of California San Diego, 9452 Medical Center Drive, ACTRI 1W501, La Jolla, CA, 92093, USA. sis040@ucsd.edu. 6. Division of Biomedical Informatics, University of California San Diego, La Jolla, CA, USA. sis040@ucsd.edu.
Abstract
BACKGROUND AND AIMS: Gastrointestinal pathogen panels (GPPs) are increasingly being used for evaluation of diarrhea. The impact of these tests on patients with inflammatory bowel diseases (IBD) is unknown. We performed a time-interrupted cohort study comparing GPPs and conventional stool evaluation in patients with IBD with diarrhea. METHODS: We included 268 consecutive patients with IBD who underwent GPP (BioFire Diagnostics®) (n = 134) or conventional stool culture and Clostridium difficile polymerase chain reaction testing (n = 134) during suspected IBD flare between 2012 and 2016. Primary outcome was composite of 30-day IBD-related hospitalization, surgery, or emergency department visit; secondary outcome was IBD treatment modification. RESULTS: Overall, 41/134 (30.6%) patients tested positive on GPP (18 C. difficile, 17 other bacterial infections, and 6 viral pathogens) versus 14/134 patients (10.4%, all C. difficile) testing positive on conventional testing. Rate of IBD treatment modification in response to stool testing was lower in GPP group as compared conventional stool testing group (35.1 vs. 64.2%, p < 0.01). On multivariate analysis, diagnostic evaluation with GPP was associated with three times higher odds of IBD-related hospitalization/surgery/ED visit (95% CI, 1.27-7.14), as compared to conventional stool testing. This negative impact was partly mediated by differences in ordering provider specialty, with non-gastroenterologists more likely to order GPP as compared to gastroenterologists. CONCLUSIONS: In patients with suspected flare of IBD, GPPs have higher pathogen detection rate and lead to lower rate of IBD treatment modification. A diagnostic testing strategy based on GPPs is associated with higher hospital-related healthcare utilization as compared to conventional stool testing, particularly when utilized by non-gastroenterologists.
BACKGROUND AND AIMS: Gastrointestinal pathogen panels (GPPs) are increasingly being used for evaluation of diarrhea. The impact of these tests on patients with inflammatory bowel diseases (IBD) is unknown. We performed a time-interrupted cohort study comparing GPPs and conventional stool evaluation in patients with IBD with diarrhea. METHODS: We included 268 consecutive patients with IBD who underwent GPP (BioFire Diagnostics®) (n = 134) or conventional stool culture and Clostridium difficile polymerase chain reaction testing (n = 134) during suspected IBD flare between 2012 and 2016. Primary outcome was composite of 30-day IBD-related hospitalization, surgery, or emergency department visit; secondary outcome was IBD treatment modification. RESULTS: Overall, 41/134 (30.6%) patients tested positive on GPP (18 C. difficile, 17 other bacterial infections, and 6 viral pathogens) versus 14/134 patients (10.4%, all C. difficile) testing positive on conventional testing. Rate of IBD treatment modification in response to stool testing was lower in GPP group as compared conventional stool testing group (35.1 vs. 64.2%, p < 0.01). On multivariate analysis, diagnostic evaluation with GPP was associated with three times higher odds of IBD-related hospitalization/surgery/ED visit (95% CI, 1.27-7.14), as compared to conventional stool testing. This negative impact was partly mediated by differences in ordering provider specialty, with non-gastroenterologists more likely to order GPP as compared to gastroenterologists. CONCLUSIONS: In patients with suspected flare of IBD, GPPs have higher pathogen detection rate and lead to lower rate of IBD treatment modification. A diagnostic testing strategy based on GPPs is associated with higher hospital-related healthcare utilization as compared to conventional stool testing, particularly when utilized by non-gastroenterologists.
Authors: Holger J Schünemann; A Holger J Schünemann; Andrew D Oxman; Jan Brozek; Paul Glasziou; Roman Jaeschke; Gunn E Vist; John W Williams; Regina Kunz; Jonathan Craig; Victor M Montori; Patrick Bossuyt; Gordon H Guyatt Journal: BMJ Date: 2008-05-17
Authors: Ashwin N Ananthakrishnan; Charles N Bernstein; Dimitrios Iliopoulos; Andrew Macpherson; Markus F Neurath; Raja A Raja Ali; Stephan R Vavricka; Claudio Fiocchi Journal: Nat Rev Gastroenterol Hepatol Date: 2017-10-11 Impact factor: 46.802
Authors: Jordan E Axelrad; Andrew Joelson; Peter H R Green; Garrett Lawlor; Simon Lichtiger; Ken Cadwell; Benjamin Lebwohl Journal: Am J Gastroenterol Date: 2018-08-03 Impact factor: 10.864
Authors: Karoline Freeman; Alexander Tsertsvadze; Sian Taylor-Phillips; Noel McCarthy; Hema Mistry; Rohini Manuel; James Mason Journal: PLoS One Date: 2017-03-02 Impact factor: 3.240
Authors: Jordan E Axelrad; Andrew Joelson; Yael R Nobel; Garrett Lawlor; Peter H R Green; Simon Lichtiger; Benjamin Lebwohl Journal: Inflamm Bowel Dis Date: 2017-06 Impact factor: 7.290
Authors: Fernando Magro; Catarina Alves; Mafalda Santiago; Paula Ministro; Paula Lago; Luís Correia; Raquel Gonçalves; Diana Carvalho; Francisco Portela; Cláudia Camila Dias; Axel Dignass; Silvio Danese; Laurent Peyrin-Biroulet; Maria Manuela Estevinho; Paula Moreira Journal: United European Gastroenterol J Date: 2021-12-14 Impact factor: 4.623
Authors: Soonwook Hong; Timothy A Zaki; Michael Main; Ashley M Hine; Shannon Chang; David Hudesman; Jordan E Axelrad Journal: Inflamm Bowel Dis Date: 2021-10-18 Impact factor: 7.290