TOPLINE

Compared with conventional stool culture, multiplex gastrointestinal polymerase chain reaction (GI PCR) testing was associated with a shorter average length of hospital stay among patients admitted for suspected infectious gastroenteritis. Those who underwent GI PCR had more than fivefold higher odds of receiving targeted antibiotic therapy.

METHODOLOGY

• Although GI PCR testing offers faster and broader detection of pathogens than conventional stool culture, evidence comparing the real-world clinical impact of the two approaches in patients hospitalized for GI infections has been limited.
• Researchers conducted a retrospective cohort study between January 2019 and September 2024 at a midsized hospital in the US that used a unified Epic electronic health record system to assess how GI PCR and stool culture affected the length of hospital stay, antibiotic use, and procedural resource use.
• The analysis included 408 adult patients (median age, 62 years; 51.2% women) who were hospitalized with a clinical suspicion of infectious gastroenteritis and had a positive stool culture, GI PCR test, or both within 48 hours of admission.
• Patients were assigned to one of three groups according to the test that yielded a positive result: stool culture only (n = 154), GI PCR only (n = 153), or both (n = 101).
• The primary outcome was length of hospital stay; secondary outcomes were prescription of targeted antibiotic therapy, antibiotic duration, and inpatient colonoscopy for persistent GI symptoms.

TAKEAWAY

• GI PCR testing was associated with a more than 30% reduction in the mean length of hospital stay compared with stool culture alone (incidence rate ratio [IRR], 0.664; P < .001), whereas combined testing did not show any significant difference from culture.
• Patients who tested positive on GI PCR had more than fivefold higher odds of receiving targeted antibiotic therapy (adjusted odds ratio [aOR], 5.38) than those who tested positive on stool culture test only, with a similar benefit seen among those who tested positive on both tests (aOR, 5.83; P < .001 for both).
• The median antibiotic duration was similar across all groups; however, the GI PCR group showed greater variability in treatment duration (variance IRR, 2.76; P = .003), suggesting more individualized prescribing patterns.
• Although inpatient colonoscopy was uncommon (2.0% overall), its rates were similar across groups, but the numbers were too small for a formal statistical comparison.

IN PRACTICE

“These findings support the integration of GI PCR as the primary diagnostic modality in clinical workflows, with stool culture reserved for selected cases requiring resistance profiling or public health surveillance,” the authors of the study wrote.

SOURCE

The study was led by Bolaji Ayinde, MD, Graduate Medical Education, Northeast Georgia Medical Center, Gainesville, Georgia. It was published online in the Journal of Clinical Gastroenterology.

LIMITATIONS

The retrospective design may have introduced selection bias, and baseline differences in the distribution of pathogens between groups may have influenced outcomes. The single-center findings may have limited the generalizability of the results to other practice settings. The study did not directly assess costs.

DISCLOSURES

Funding details were not explicitly mentioned for the study. The authors declared having no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.