Mapping of aetiologies of gastroenteritis: a systematic review and meta-analysis of pathogens identified using a multiplex screening array

Emergence of molecular methods to screen stools could provide a more complete picture of pathogens causing gastroenteritis, allowing to adequately treat patients whenever required but, so far, no aggregate data have been released. Our objective was to report pathogens identified in patients suffering from gastroenteritis using a multiplex molecular array. Medline and Embase were searched for original publications reporting pathogens identified with FilmArray GI panel in patients suffering from gastroenteritis. Proportions of pathogens were extracted and pooled using a model with random effects. Fourteen studies (17,815 patients) were included in the analysis. Among the 7,071 patients (39.7%) with positive FilmArray, identified pathogens were <i>EPEC</i> (27.5%), <i>Clostridium difficile</i> (19.3%), <i>Norovirus</i> (15.1%), <i>EAEC</i> (15%), <i>Campylobacter spp</i> (11.8%), <i>Salmonella spp</i> (8.1%), <i>ETEC</i> (7.3%), <i>Rotavirus</i> (7.3%), <i>Sapovirus</i> (7.1%), <i>STEC</i> (5.2%), <i>Shigella/EIEC</i> (4.9%), <i>Giardia lamblia</i> (4%), <i>Adenovirus</i> (3.8%), <i>Cryptosporidium spp</i> (3.8%), <i>Astrovirus</i> (2.8%), <i>Yersinia enterocolitica</i> (1.7%), <i>Escherichia coli</i> O157 (1.1%), <i>Plesiomonas shigelloides</i> (1.1%), <i>Cyclospora cayetanensis</i> (0.7%), <i>Vibrio spp</i> (0.5%), <i>Vibrio cholerae</i> (0.3%) and <i>Entamoeba histolytica</i> (0.3%). When considering only studies with control group (microbiological examination of the stools performed by other methods), FilmArray identified at least one pathogen in 48.2% of patients versus 16.7% when using comparative diagnostic methods. FilmArray GI panel was positive in 39.7% of patients suffering from gastroenteritis. This proportion has to be mitigated by the carriage rates of identified organisms. Ultimately, restricted ordering of molecular panels to those patients who might benefit from specific treatment could provide medical value by swift identification of the pathogen and more targeted therapy.

粪便筛查分子检测技术的兴起，可更全面地揭示引发胃肠炎的病原体全貌，从而在必要时为患者提供精准治疗；但截至目前，相关汇总数据尚未公开。本研究旨在通过多重分子芯片技术，报告胃肠炎患者体内检出的病原体谱。本研究检索了Medline与Embase数据库，筛选以FilmArray GI检测板（FilmArray GI panel）对胃肠炎患者进行病原体检测的原创性研究。提取各研究中病原体检出比例，并采用随机效应模型进行汇总分析。最终共纳入14项研究，涉及17815例患者。在7071例FilmArray检测阳性的患者（占比39.7%）中，检出的病原体依次为：肠致病性大肠埃希菌（Enteropathogenic Escherichia coli, EPEC，27.5%）、艰难梭菌（19.3%）、诺如病毒（15.1%）、肠集聚性大肠埃希菌（Enteroaggregative Escherichia coli, EAEC，15%）、弯曲菌属（Campylobacter spp.，11.8%）、沙门菌属（Salmonella spp.，8.1%）、产肠毒素大肠埃希菌（Enterotoxigenic Escherichia coli, ETEC，7.3%）、轮状病毒（7.3%）、沙波病毒（7.1%）、产志贺毒素大肠埃希菌（Shiga toxin-producing Escherichia coli, STEC，5.2%）、志贺菌/肠侵袭性大肠埃希菌（Shigella/EIEC，4.9%）、蓝氏贾第鞭毛虫（4%）、腺病毒（3.8%）、隐孢子虫属（Cryptosporidium spp.，3.8%）、星状病毒（2.8%）、小肠结肠炎耶尔森菌（1.7%）、大肠埃希菌O157（1.1%）、类志贺邻单胞菌（1.1%）、卡晏环孢子球虫（0.7%）、弧菌属（Vibrio spp.，0.5%）、霍乱弧菌（0.3%）及溶组织内阿米巴（0.3%）。在仅纳入设置对照组的研究（即采用其他方法进行粪便微生物学检测）时，FilmArray检测的病原体阳性率为48.2%，而采用对比诊断方法的阳性率仅为16.7%。胃肠炎患者中FilmArray GI检测板的总体阳性率为39.7%。该阳性率需结合检出病原体的定植率进行校正。最终，仅对可能从特异性治疗中获益的患者开具分子检测面板，可通过快速明确病原体、实施更具针对性的治疗，从而产生临床应用价值。