Published online Sep 6, 2020. doi: 10.12998/wjcc.v8.i17.3708
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
Stool multiplex polymerase chain reaction (PCR) assay has been suggested to be highly specific and sensitive compared to conventional methods. Thus, its efficacy should be evaluated in clinical practice. Further, the efficacy of fecal calprotectin in acute infectious diarrhea has not been elucidated in adults.
Several studies have investigated the efficacy of stool multiplex PCR assay and calprotectin test in children with acute infectious diarrhea. However, studies on adult patients are limited.
We aimed to evaluate the efficacy of stool multiplex PCR test and fecal calprotectin expression in adult patients with acute infectious diarrhea.
We reviewed clinical and laboratory findings and compared the clinical characteristics according to the positivity of stool PCR. We performed a multivariate logistic regression analysis to determine the factors predicting positivity of stool PCR. Using ROC analysis, we evaluated the diagnostic efficacy of calprotectin expression in detecting bacterial pathogens by stool PCR.
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%). C-reactive protein (CRP) (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).
Stool multiplex 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 CRP 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.
We suggest that stool multiplex PCR and calprotectin test may improve the diagnosis of acute infectious diarrhea in adults. Future prospective studies are warranted.