title: Systematic application of multiplex PCR enhances the detection of bacteria, parasites, and viruses in stool samples.
abstract: OBJECTIVE
  To determine whether systematic testing of faecal samples with a broad range multiplex PCR increases the diagnostic yield in patients with diarrhoea compared with conventional methods and a clinician initiated testing strategy.
  
  
  METHODS
  1758 faecal samples from 1516 patients with diarrhoea submitted to two diagnostic laboratories were tested for viral, bacterial, and parasitic pathogens by Fast-Track Diagnostics multiplex real-time PCR kits and conventional diagnostic tests.
  
  
  RESULTS
  Multiplex PCR detected pathogens in 530 samples (30%): adenovirus (51, 3%), astrovirus (95, 5%), norovirus (172, 10%), rotavirus (3, 0.2%), Campylobacter jejuni/coli (85, 5%), Salmonella spp. (22, 1%), Clostridium difficile (72, 4%), entero-haemorrhagic Escherichia coli (21, 1%), Cryptosporidium spp. (3, 0.2%), Entamoeba histolytica (1, 0.1%), and Giardia lamblia (59, 3%). In contrast, conventional testing detected a pathogen in 324 (18%) samples.
  
  
  CONCLUSIONS
  Using a systematic approach to the diagnosis of gastroenteritis improved diagnostic yield. This enhanced detection with PCR was achieved by a combination of improved detection of individual pathogens and detection of pathogens not requested or unable to be tested by conventional tests. This approach also allowed earlier identification for most pathogens and created a workflow which is likely to adapt well for many diagnostic laboratories.
authors.affiliation: Canterbury Health Laboratories, P O Box 151, Christchurch 8140, New Zealand. GMcAuliffe@adhb.govt.nz
authors.forename: Gary N
authors.initials: GN
authors.lastname: McAuliffe
authors.forename: Trevor P
authors.initials: TP
authors.lastname: Anderson
authors.forename: Mary
authors.initials: M
authors.lastname: Stevens
authors.forename: Jacqui
authors.initials: J
authors.lastname: Adams
authors.forename: Robyn
authors.initials: R
authors.lastname: Coleman
authors.forename: Patalee
authors.initials: P
authors.lastname: Mahagamasekera
authors.forename: Sheryl
authors.initials: S
authors.lastname: Young
authors.forename: Tom
authors.initials: T
authors.lastname: Henderson
authors.forename: Maria
authors.initials: M
authors.lastname: Hofmann
authors.forename: Lance C
authors.initials: LC
authors.lastname: Jennings
authors.forename: David R
authors.initials: DR
authors.lastname: Murdoch
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D001419:Bacteria / Q000235:genetics / Q000302:isolation & purification*; D002648:Child; D002675:Child, Preschool; D003967:Diarrhea / Q000175:diagnosis* / Q000382:microbiology / Q000469:parasitology / Q000821:virology; D005243:Feces / Q000382:microbiology / Q000469:parasitology / Q000821:virology; D005260:Female; D005759:Gastroenteritis / Q000175:diagnosis* / Q000382:microbiology / Q000469:parasitology / Q000821:virology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D025202:Molecular Diagnostic Techniques / Q000379:methods*; D060885:Multiplex Polymerase Chain Reaction / Q000379:methods*; D010271:Parasites / Q000235:genetics / Q000302:isolation & purification*; D012680:Sensitivity and Specificity; D013997:Time Factors; D014780:Viruses / Q000235:genetics / Q000302:isolation & purification*; D055815:Young Adult