Clinical Impact of Multiplex Molecular Diagnostic Testing in Children With Acute Gastroenteritis Presenting to an Emergency Department: A Multicenter Prospective Study.

Autor:	Pavia AT; Departments of Pediatrics and Internal Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA., Cohen DM; Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA., Leber AL; Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA., Daly JA; Department of Pathology, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA., Jackson JT; Children's Mercy Hospital, Kansas City, Missouri, USA., Selvarangan R; Children's Mercy Hospital, Kansas City, Missouri, USA., Kanwar N; Children's Mercy Hospital, Kansas City, Missouri, USA., Bender JM; Children's Hospital of Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, USA., Dien Bard J; Children's Hospital of Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, USA., Festekjian A; Children's Hospital of Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, USA., Duffy S; Department of Emergency Medicine, Hasbro Children's Hospital, Alpert Medical School, Brown University, Providence, Rhode Island, USA., Larsen C; Departments of Pediatrics and Internal Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA., Holmberg KM; bioMérieux, Salt Lake City, Utah, USA., Bardsley T; Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, Utah, USA., Haaland B; Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, Utah, USA., Bourzac KM; bioMérieux, Salt Lake City, Utah, USA., Stockmann C; Departments of Pediatrics and Internal Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA., Chapin KC; Department of Pathology and Laboratory Medicine, Rhode Island Hospital, Alpert Medical School, Brown University, Providence, Rhode Island, USA., Leung DT; Departments of Pediatrics and Internal Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA.; Department of Pathology, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA.
Jazyk:	angličtina
Zdroj:	Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [Clin Infect Dis] 2024 Mar 20; Vol. 78 (3), pp. 573-581.
DOI:	10.1093/cid/ciad710
Abstrakt:	Background: Multiplex molecular diagnostic panels have greatly enhanced detection of gastrointestinal pathogens. However, data on the impact of these tests on clinical and patient-centered outcomes are limited. Methods: We conducted a prospective, multicenter, stepped-wedge trial to determine the impact of multiplex molecular testing at 5 academic children's hospitals on children presenting to the emergency department with acute gastroenteritis. Caregivers were interviewed on enrollment and 7-10 days after enrollment to determine symptoms, risk factors, subsequent medical visits, and impact on family members. During the pre-intervention period, diagnostic testing was performed at the clinician's discretion . During the intervention period, multiplex molecular testing was performed on all children, with results available to clinicians. The primary outcome was return visits to a healthcare provider within 10 days of enrollment. Results: Potential pathogens were identified by clinician-ordered tests in 19 of 571 (3.3%) in the pre-intervention period compared with 434 of 586 (74%) in the intervention period; clinically relevant pathogens were detected in 2.1% and 15%, respectively. In the multivariate model, the intervention was associated with a 21% reduction in the odds of any return visit (odds ratio, 0.79; 95% confidence interval, .70-.90) after adjusting for potential confounders. Appropriate treatment was prescribed in 11.3% compared with 19.6% during the intervention period (P = .22). Conclusions: Routine molecular multiplex testing for all children who presented to the ED with acute gastroenteritis detected more clinically relevant pathogens and led to a 21% decrease in return visits. Additional research is needed to define patients most likely to benefit from testing. Clinical Trials Registration. NCT02248285. Competing Interests: Potential conflicts of interest. J. D. B reports research support and consulting funding from bioMerieux. R. S. reports reseach funding from Biomerieux, Hologic, Qiagen, Abbott, Cepheid, and Luminex. J. M. B reports consulting fees from Gradientech. J. D. B. reports consulting fees from bioMerieux. K. M. H. and K. M. B. are employees of bioMerieux. A. M. L. reports consulting or research funding from Cepheid, Meridian Diagnostics, Diasorin, and Hologic. All other authors report no potential conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed. (© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
Databáze:	MEDLINE
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