Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 6, 2020; 8(17): 3708-3717
Published online Sep 6, 2020. doi: 10.12998/wjcc.v8.i17.3708
Efficacy of stool multiplex polymerase chain reaction assay in adult patients with acute infectious diarrhea
Jae Sung Ahn, Seung In Seo, Jinseob Kim, Taewan Kim, Jin Gu Kang, Hyoung Su Kim, Woon Geon Shin, Myoung Kuk Jang, Hak Yang Kim
Jae Sung Ahn, Taewan Kim, Jin Gu Kang, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Seoul KS013, South Korea
Seung In Seo, Hyoung Su Kim, Woon Geon Shin, Myoung Kuk Jang, Hak Yang Kim, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul KS013, South Korea
Seung In Seo, Hyoung Su Kim, Woon Geon Shin, Myoung Kuk Jang, Hak Yang Kim, Institute for Liver and Digestive Diseases, Hallym University, Chuncheon KS013, South Korea
Jinseob Kim, Department of Epidemiology, School of Public Health, Seoul National University, Seoul KS013, South Korea
Author contributions: Seo SI designed the research study; Ahn JS and Seo SI performed the research; Kim JS contributed statistical analysis; Seo SI, Kim TW, Kang JG and Kim HS analyzed the data; Shin WG, Jang MK and Kim HY provided material support; Seo SI and Ahn JS wrote the manuscript. All authors have read and approve the final manuscript.
Supported by Kangdong Sacred Heart Hospital Fund, No. 2017-07.
Institutional review board statement: The protocol for this study was approved by the institutional review board of Kangdong Sacred Heart Hospital, No. 2020-02-008.
Informed consent statement: We received exemption of informed consent.
Conflict-of-interest statement: All authors have no any conflicts of interest.
Data sharing statement: No additional data.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Seung In Seo, MD, Assistant Professor, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, 445, Gil-dong, Kangdong-gu, Seoul KS013, South Korea. doctorssi@kdh.or.kr
Received: March 11, 2020
Peer-review started: March 11, 2020
First decision: April 25, 2020
Revised: June 4, 2020
Accepted: August 1, 2020
Article in press: August 1, 2020
Published online: September 6, 2020
Processing time: 177 Days and 0.8 Hours
Abstract
BACKGROUND

Recently, stool multiplex polymerase chain reaction (PCR) tests have been developed for identifying diarrhea-causing bacterial pathogens. Furthermore, fecal calprotectin is a well-known effective marker for intestinal mucosal inflammation.

AIM

To evaluate the efficacy of stool multiplex PCR and fecal calprotectin in acute infectious diarrhea.

METHODS

Overall, 400 patients with acute infectious diarrhea were enrolled from Kangdong Sacred Heart Hospital (January 2016 to December 2018). Multiplex PCR detected 7 enteropathogenic bacteria including Salmonella, Campylobacter, Shigella, Escherichia coli O157:H7, Aeromonas, Vibrio, and Clostridium difficile. We reviewed clinical and laboratory findings using stool multiplex PCR.

RESULTS

Stool multiplex PCR test detected considerably more bacterial pathogens than stool culture (49.2% vs 5.2%), with Campylobacter as the most common pathogen (54%). Patients with positive stool PCR showed elevated fecal calprotectin expression compared to patients with negative stool PCR (1124.5 ± 816.9 mg/kg vs 609 ± 713.2 mg/kg, P = 0.001). C-reactive protein (OR = 1.01, 95%CI: 1.001-1.027, P = 0.034) and sigmoidoscopy-detected colitis (OR = 4.76, 95%CI: 1.101-20.551, P = 0.037) were independent factors in stool PCR-based detection of bacterial pathogens. Sensitivity and specificity of calprotectin were evaluated to be 70.5% and 60.9%, respectively (adjusted cut-off value = 388 mg/kg).

CONCLUSION

Stool multiplex PCR test has increased sensitivity in detecting pathogens than conventional culture, and it is correlated with calprotectin expression. Stool multiplex PCR and calprotectin may be effective in predicting clinical severity of infectious diarrhea.

Keywords: Acute infectious diarrhea; Stool multiplex polymerase chain reaction; Calprotectin

Core tip: Stool multiplex polymerase chain reaction (PCR) test showed improved sensitivity than conventional culture method in detecting bacterial pathogens in hospitalized patients with acute infectious diarrhea. Patients with positive stool PCR showed higher C-reactive protein expression level and colitis on sigmoidoscopy. Fecal calprotectin was found to correlate with the positivity of stool PCR, and the adjusted cut-off value of calprotectin for detecting bacterial pathogens by stool PCR was found to be 388 mg/kg.