Diagnostic syndromic multiplex approaches for gastrointestinal infections

ABSTRACT

Introduction: Gastrointestinal diseases due to infectious pathogens currently represent an important global health concern, especially in children and developing countries. Early and accurate detection of gastrointestinal pathogens is important to initiate the appropriate type of therapy. Multiplex molecular gastrointestinal panels rapidly detect several gastrointestinal pathogens at once with high sensitivity.

Areas covered: We assess the scope and limitations of several multiplex gastrointestinal panels approved by the Food and Drug Administration or marked by Conformité Européenne–in vitro diagnostic. We compare 10 syndromic gastrointestinal panels, 14 bacteria-specific multiplex panels, seven parasite-specific multiplex panels, and eight virus-specific multiplex panels.

Expert opinion: Thanks to the advances made in the diagnostic approaches for gastrointestinal infections, there are various panels to choose. The choice of a specific syndromic gastrointestinal multiplex panel should be made to improve patient care. Diagnostic syndromic multiplex approaches for gastrointestinal infections should be customized; each hospital should develop its diagnostic algorithm for gastrointestinal infections tailored to its setting, study population, and geographical site. Current multiplex gastrointestinal panels could be improved by including the detection of antimicrobial resistance, toxigenic Clostridioides difficile, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, the virus responsible for the COVID-19 pandemic).

KEYWORDS:

• Diagnostic
• gastrointestinal
• multiplex
• syndromic

Article highlights

• Gastrointestinal diseases due to infectious pathogens currently represent an important global health concern, especially in children and developing countries.

• Diagnosing gastrointestinal infections using multiplex panels offers the advantages of increased analytical sensitivity, reduced sample volume requirement, wide-ranging pathogen coverage, enhanced ability to detect coinfections, and faster reporting, compared to conventional methods like culturing and microscopy.

• Multiplex panels have differences in the number of pathogens included, sample processing methods, and systems for analysis interpretation. Moreover, some panels have the capability of nucleic acid extraction, while others do not, and some have the capability of processing only one sample at a time, while others can process several samples simultaneously.

• Using such gastrointestinal multiplex panels has improved patient care, having efficient and rapid results, and helped reduce the use of additional diagnostic tests (e.g., endoscopy, abdominal radiography), unnecessary antibiotics, hospital length of stay, and the overall healthcare costs per patient.

• Diagnostic syndromic multiplex approaches for gastrointestinal infections should be customized, and each hospital should develop its own diagnostic algorithm for gastrointestinal infections tailored to its setting, study population, and geographical site, among other factors.

• Improving the current multiplex gastrointestinal panels depends on including antimicrobial resistance detection, toxigenic Clostridioides difficile detection, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, the virus responsible for the COVID-19 pandemic) detection.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.