P-152. Comparison of Target Detection Rates of Multiplex Gastrointestinal PCR Panels: A Systematic Literature Review and Meta-analysis

TL;DR

This study compares how well different multiplex PCR panels detect gastrointestinal infections, finding that a smaller panel can reduce overdiagnosis while still capturing most clinically relevant cases.

Contribution

The study introduces a novel approach to estimate the performance of an 11-target panel by analyzing subsets of larger panels.

Findings

The 11-target panel captured 39.7% of the 22-target panel's detections and 57.3% of the 15-target panel's detections.

Larger panels like the 22-target and 15-target had pooled detection rates of 50% and 32.94%, respectively.

The 11-target panel reduced co-detection of organisms like C. difficile and E. coli that may not be clinically relevant.

Abstract

Multiplex gastrointestinal (GI) panels allow rapid detection of a broad range of targets in patients with suspected infectious gastroenteritis (IG). Larger multiplex panels such as a 22- & 15-target panel (22t, 15t) may also detect (or co-detect) colonizing or non-etiologic organisms. This can increase diagnostic uncertainty, overtreatment and healthcare costs. To evaluate the performance of a more focused approach, we performed a systematic literature review (SLR) and meta-analysis (MA) to estimate detection frequency of an 11-target (11t) multiplex GI panel compared to larger panels.Figure 1:PRISMA Flow DiagramTable 1:Comparison of Pooled Proportion – BioFire 22-target, Luminex xTAG 15-target & 11-target panel

PRISMA Flow Diagram

Comparison of Pooled Proportion – BioFire 22-target, Luminex xTAG 15-target & 11-target panel

We searched PubMed and EMBASE (Jan 2020-Aug 2024) for studies reporting target positivity in suspected IG patients, focusing on 22t & 15t panels. Pooled detection rates were estimated via random-effects meta-analysis. Because no published studies directly evaluated an 11t panel, we estimated its detection using pooled positivity rates for the subsets of targets from larger panels (22t & 15t). Relative detection frequency was then estimated by comparing co-detection-adjusted positivity rates of 11t panel with 22t & 15t panels.Table 2:Study and Patient Characteristics: BioFire FilmArray (18 Studies)Table 3:Study and Patient Characteristics: Luminex xTAG (8 Studies)

Study and Patient Characteristics: BioFire FilmArray (18 Studies)

Study and Patient Characteristics: Luminex xTAG (8 Studies)

The SLR and MA included 25 studies, 18 evaluating the 22t & 8 assessing the 15t panels (Figure 1). The adjusted pooled detection for the 22t & 15t panels was 50% & 32.94%, respectively. The 11t panel captured 39.7% & 57.3% of 22t & 15t panels, respectively, suggesting a targeted panel would retain a clinically actionable diagnostic yield by reducing C. difficile & certain E. coli strains that may be co-detected due to colonization.

Although larger multiplex GI panels yield more positive results, they may contribute to overdiagnosis by detecting non-etiologic or colonizing organisms, including C. difficile & E. coli, in patients without clinical risk factors or indications for testing those specific targets. An 11t panel captured a meaningful proportion of clinically relevant targets while reducing over- or co-detection of colonizers and pathogens with limited relevance to patient management. These findings align with IDSA & AMP/ASM guidance promoting targeted multiplex testing and support their use improving diagnostic stewardship, limit overtreatment and reduce healthcare costs.

Jordan Chase, BA, Danaher: Stocks/Bonds (Public Company) Darsh Devani, MS, Cepheid: Advisor/Consultant|Cepheid: Grant/Research Support Bridget Manning, MS, Cepheid: Advisor/Consultant|Cepheid: Grant/Research Support Lucas Schulz, PharmD, AbbVie: Advisor/Consultant|Cepheid: Employee Thomas Goss, PharmD, Cepheid: Advisor/Consultant|Cepheid: Grant/Research Support

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