P2336 - Multiplex Gastrointestinal Pathogen Panel Testing Is Associated With Higher Diagnostic Yield and Identification of Pathogenic E. coli Species in Patients With Travelers’ Diarrhea

Soonwook Hong, MD¹, Timothy A. Zaki, MD², Michael Main, MD³, Ashley Hine, BS⁴, Ken Cadwell, PhD¹, Jordan Axelrad, MD, MPH^1
1New York University School of Medicine, New York, NY; ²University of Texas Southwestern Medical Center, Dallas, TX; ³Vanderbilt University Medical Center, Nashville, TN; ⁴University of Connecticut School of Medicine, Farmington, CT

Introduction: Traveler’s diarrhea is the most common travel related illness and is often encountered in the outpatient setting. Most pathogens that cause traveler’s diarrhea are poorly characterized by conventional stool testing such as stool culture and ova and parasite exam. Multiplex polymerase chain-reaction based gastrointestinal pathogen panels (GI PCR) offer advantages in sensitivity and turnaround time, however their impact on clinical management is unclear. Our aim was to evaluate the clinical impact of GI PCR testing in outpatients presenting with traveler’s diarrhea.

Methods: We performed a retrospective study comparing outpatients presenting with acute gastrointestinal symptoms at an academic medical center who received stool testing with GI PCR from September 2015 to April 2019, to patients who presented with similar symptoms from February 2009 to April 2012, when GI PCR was unavailable, and received stool culture and ova and parasite exam (“conventional testing”). Patients who received GI PCR were matched by age and sex to patients who received conventional testing. We recorded pathogens isolated, demographic data, history of travel within 30 days of presentation, presenting symptoms and rates of antibiotic therapy.

Results: We identified 1,018 outpatients who received GI PCR or conventional stool testing. (n=509 each). There were 70 patients in the conventional cohort and 78 in the GI PCR cohort, respectively, with traveler’s diarrhea. In patients who received GI PCR, we observed higher diagnostic yield in patients with traveler’s diarrhea who received GI PCR, compared to patients without a history of recent travel (54 vs. 39%, p=0.01, Table 1). There was no difference in diagnostic yield in patients who received conventional stool testing (9 vs 10%, p=0.74). Patients with travelers’ diarrhea were more likely to have pathogenic species of Escherichia coli (E. coli) identified on testing (45 vs. 22%, p< 0.01, Table 2), particularly Enteroaggregative E. coli (23 vs. 6%, p< 0.01). Patients with traveler’s diarrhea were more likely to receive antibiotics whether they received GI PCR (38 vs. 27%, p=0.04) or conventional testing (35 vs. 25%, p=0.06)

Discussion: GI PCR was associated with a higher diagnostic yield in patients presenting with travelers’ diarrhea. Patients with travelers’ diarrhea were significantly more likely to have pathogenic E. coli species identified on PCR testing, with up to 45% of patients testing positive.



Disclosures:


Soonwook Hong, MD¹, Timothy A. Zaki, MD², Michael Main, MD³, Ashley Hine, BS⁴, Ken Cadwell, PhD¹, Jordan Axelrad, MD, MPH¹. P2336 - Multiplex Gastrointestinal Pathogen Panel Testing Is Associated With Higher Diagnostic Yield and Identification of Pathogenic E. coli Species in Patients With Travelers’ Diarrhea, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.