Impact of Multiplex Testing on the Identification of Pediatric Clostridiodes Difficile
Impact of Multiplex Testing on the Identification of Pediatric Clostridiodes Difficile
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DOI：
10.1016/j.jpeds.2019.11.036
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发表时间：
2020-03-01
影响因子：
5.1
通讯作者：
Dominguez, Samuel R.
中科院分区：
文献类型：
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作者：
Cotter, Jillian M.;Thomas, Jacob;Dominguez, Samuel R.
目的评价多重胃肠道病原学专家组(GIP)的实施是否与艰难梭菌(艰难梭菌)检测和检测率的变化有关。研究设计：采用中断时间序列分析进行观察性研究，纳入能够检测艰难梭菌的儿童患者。从2013年到2015年(“传统诊断时代”)，粪便检测包括艰难梭菌选择性聚合酶链式反应和其他病原体特异性检测。从2015年到2017年(“GIP时代”)，艰难梭菌聚合酶链式反应与GIP一起提供，后者检测到包括艰难梭菌在内的22种病原体，取代了对额外检测的需要。结果共进行了6841次艰难梭菌检测，1214次艰难梭菌检测呈阳性。在三个环境中，与传统诊断时代相比，GIP Era的艰难梭菌检测(1.7-2.3倍)和艰难梭菌检测率(1.9-3.4倍)明显更高。在对进行的测试次数进行调整后，检测率不再有显著差异。在艰难梭菌阳性的金黄色葡萄球菌中，31%的患者与另一种细菌混合感染。在GIP检测中，1岁儿童的艰难梭菌阳性百分率显著高于2岁儿童(P=.02)和3-18岁儿童(P<；.01)。患有艰难梭菌的儿童较小的儿童更容易合并感染(P<；.01)。结论引入多重小组导致艰难梭菌检测的增加，从而提高艰难梭菌的检测率和对定植患者的潜在识别和治疗。这突出了诊断管理的一个重要目标和与多重测试相关的挑战。
Objectives To evaluate whether the implementation of a multiplex gastrointestinal pathogen panel (GIP) was associated with changes in Clostridioides difficile (C difficile) testing and detection rates.Study design We conducted an observational study using interrupted time series analysis and included pediatric patients with testing capable of detecting C difficile. From 2013 to 2015 ("conventional diagnostic era"), stool testing included C difficile-selective polymerase chain reaction and other pathogen-specific tests. From 2015 to 2017 ("GIP era"), C difficile polymerase chain reaction was available along with the GIP, which detected 22 pathogens including C difficile, and replaced the need for additional tests. Outcomes included C difficile testing and detection rates in ambulatory, emergency department, and inpatient settings.Results There were 6841 tests performed and 1214 C difficile positive results. Across the 3 settings, GIP era had significantly higher C difficile testing (1.7-2.3 times higher) and C difficile detection rates (1.9-3.4 times higher) compared with conventional diagnostic era. After adjusting for the number of tests performed, detection rates were no longer significantly different. Of C difficile positive GIPs, 31 % were coinfected with another organism. With GIP testing, patients 1 year of age had a significantly higher C difficile percent positivity than 2-year-old (P = .02) and 3- to 18-year-old children (P < .01). Younger children with C difficile were more likely to be coinfected (P < .01).Conclusions Introducing a multiplex panel led to increased C difficile testing, which resulted in increased C difficile detection rates and potential identification and treatment of colonized patients. This highlights an important target for diagnostic stewardship and the challenges associated with multiplex testing.