A randomized control trial of a multiplex gastrointestinal PCR panel versus usual testing to assess antibiotics use for patients with infectious diarrhea in the emergency department

Authors

Andrew C. Meltzer, Department of Emergency Medicine George Washington University (GWU) School of Medicine & Health Sciences Washington District of Columbia USA.
Sophia Newton, Department of Emergency Medicine George Washington University (GWU) School of Medicine & Health Sciences Washington District of Columbia USA.
Joel Lange, Department of Emergency Medicine George Washington University (GWU) School of Medicine & Health Sciences Washington District of Columbia USA.
Nicole C. Hall, Department of Emergency Medicine George Washington University (GWU) School of Medicine & Health Sciences Washington District of Columbia USA.
Nataly Montano Vargas, Department of Emergency Medicine George Washington University (GWU) School of Medicine & Health Sciences Washington District of Columbia USA.
Yihe Huang, Department of Biostatistics and Bioinformatics George Washington University (GWU) Milken Institute School of Public Health Washington District of Columbia USA.
Seamus Moran, Department of Emergency Medicine George Washington University (GWU) School of Medicine & Health Sciences Washington District of Columbia USA.
Yan Ma, Department of Biostatistics and Bioinformatics George Washington University (GWU) Milken Institute School of Public Health Washington District of Columbia USA.

Document Type

Journal Article

Publication Date

2-1-2022

Journal

Journal of the American College of Emergency Physicians open

Volume

3

Issue

1

DOI

10.1002/emp2.12616

Keywords

Antibiotic Stewardship; PCR testing; Point‐of care testing; diagnostic testing; emergency medicine; infectious diarrhea

Abstract

Objective: This study analyzed physician treating behavior through the use of a multiplex gastrointestinal polymerase chain reaction (GI PCR) test compared with usual testing in emergency department (ED) patients with suspected acute infectious diarrhea to assess differences in antibiotic management. Methods: A prospective, single-center, randomized control trial was designed to investigate antibiotic use in ED patients with moderate to severe suspected infectious diarrhea, comparing those who received GI PCR to those who received usual testing. ED patients with signs of dehydration, inflammation, or persistent symptoms were randomized to either the experimental arm (GI PCR) or the control arm (usual testing or no testing). Results: A total of 74 patients met study criteria and were randomized to either the experimental GI PCR arm (n = 38) or to the control arm (n = 36). Participants in the GI PCR arm received antibiotics in 87% of bacterial or protozoal diarrheal infections (13/15) whereas those in the control arm received antibiotics in 46% of bacterial or protozoal infections (6/13) ( value 0.042) with 2-proportion difference 0.41 (95% confidence interval 0.07 and 0.68). Conclusions: ED use of multiplex GI PCR led to an increase in antibiotic use for bacterial and protozoal causes of infectious diarrhea compared to usual testing. This increase in antibiotics appears to be appropriate given patients' moderate to severe symptoms and a definitive identification of a likely bacterial or protozoal cause of symptoms. Results should be interpreted with caution because of the small sample size.

APA Citation

Meltzer, Andrew C.; Newton, Sophia; Lange, Joel; Hall, Nicole C.; Vargas, Nataly Montano; Huang, Yihe; Moran, Seamus; and Ma, Yan, "A randomized control trial of a multiplex gastrointestinal PCR panel versus usual testing to assess antibiotics use for patients with infectious diarrhea in the emergency department" (2022). GW Authored Works. Paper 257.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/257

Department

Emergency Medicine