Stool multiplex PCR: Does a better test equal better care?

Reviewed by Zachary Willis, MD, MPH, University of North Carolina Health Care

Investigators from Children’s Hospital Colorado reviewed over 12,000 stool tests to detect infection in patients 18 and under, including 24 months before and 24 months after they implemented multiplex stool PCR testing. Overall, the total number of stool tests to diagnose infection fell, but the percentage of patient encounters including stool testing increased by 23%, suggesting that the greater ease and convenience of the multiplex PCR-based gastrointestinal panel (GIP) increased testing. There was a significant increase in pathogen detection, from 11% to 40%; multiple pathogen detections increased from 0.4% of patients to 8.6%. Median time to results was significantly shortened and time to directed treatment also decreased from 36 to 11 hours, but only 3% of patients received treatment. Patients with bacterial or parasitic diagnoses had lower healthcare charges in the GIP era, but overall, there was no difference. The authors concluded that the GIP has benefit in certain circumstances, but the high cost and infrequency of directed therapy calls for diagnostic stewardship to target PCR-based stool testing to the patients most likely to benefit from it.


Cotter JM, Thomas J, Birkholz M, Ambroggio L, Holstein J, Dominguez SR. Clinical Impact of a Diagnostic Gastrointestinal Panel in Children. Pediatrics. 2021;147(5). doi:10.1542/peds.2020-036954

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