Clinical impact of a gastrointestinal PCR panel in children with infectious diarrhoea

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Objectives Multiplex gastrointestinal PCR (GI-PCR) allows fast and simultaneous detection of 22 enteric pathogens (includingCampylobacter, Salmonella,Shigella/enteroinvasiveEscherichia coli (EIEC), among other bacteria, parasites and viruses). However, its impact on the management of children with infectious diarrhoea remains unknown. Patients/Design All children eligible for stool culture from May to October 2018 were prospectively included in a monocentric study at Robert-Debré University-Hospital. Intervention A GI-PCR (BioFire FilmArray) was performed on each stool sample. Main measures Data on the children’s healthcare management before and after GI-PCR results were collected. Stool culture results were also reported. Results 172 children were included. The main criteria for performing stool analysis were mucous/bloody diarrhoea and/or traveller’s diarrhoea (n=130). GI-PCR’s were positive for 120 patients (70%). The main pathogens were enteroaggregativeE. coli(n=39; 23%), enteropathogenicE. coli(n=34; 20%),Shigella/EIEC (n=27; 16%) andCampylobacter(n=21; 12%). Compared with stool cultures, GI-PCR enabled the detection of 21 vs 19Campylobacter,12 vs 10Salmonella,27Shigella/EIEC vs 13Shigella, 2 vs 2Yersinia enterocolitica, 1 vs 1Plesiomonas shigelloides,respectively. Considering the GI-PCR results and before stool culture results, the medical management was revised for 40 patients (23%): 28 initiations, 2 changes and 1 discontinuation of antibiotics, 1 hospitalisation, 2 specific room isolations related toClostridioides difficileinfections, 4 additional test prescriptions and 2 test cancellations. Conclusion The GI-PCR’s results impacted the medical management of gastroenteritis for almostone-fourth of the children, and especially the prescription of appropriate antibiotic treatment before stool culture results.

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