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GI multiplex PCR testing in children with acute gastroenteritis showed high positivity and guided antibiotic stewardshipNew test cuts guesswork in children’s stomach bugs and changes antibiotic use

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Key Takeaway
Consider clinical correlation when interpreting GI multiplex PCR results in pediatric gastroenteritis to guide antibiotic decisions.

This retrospective observational study assessed the diagnostic and clinical impact of GI multiplex PCR testing (BioFire FilmArray GI panel) compared with conventional methods, including stool culture and ova/parasite testing. The population comprised 276 children aged ≤14 years admitted with acute gastroenteritis at King Abdullah Specialized Children's Hospital in Riyadh, Saudi Arabia.

GI multiplex PCR positivity was observed in 90.9% of cases. Single-pathogen detections accounted for 56.2% of results, while co-detections represented 34.8%. The most frequently identified pathogens were Salmonella (22.1%), Rotavirus A (18.1%), Norovirus (17.4%), and Clostridium difficile (17.0%).

Regarding antibiotic use, 27.4% of patients with viral infections received antibiotics, whereas 45.3% of those with bacterial infections did. Following PCR results, antibiotics were initiated in 41.3% of bacterial cases and discontinued in 39.4% of viral cases. Length of hospital stay did not differ significantly by pathogen type. No safety data, adverse events, or tolerability information were reported.

Key limitations include the need for clinical correlation, particularly regarding co-detections and pathogens with known asymptomatic carriage. As this is an observational study, causal inferences cannot be made. The results suggest a potential role for GI multiplex PCR in guiding therapy and supporting antimicrobial stewardship in pediatric acute gastroenteritis.

This doesn’t mean the test replaces a doctor’s judgment.

The study included 276 children aged 14 and younger who were admitted with gastroenteritis between January 2022 and December 2024. Most were infants between 1 and 23 months old. Researchers used a rapid GI multiplex PCR test that checks for many viruses and bacteria in one go. They also looked at how doctors changed treatment after seeing the results.

The test found a cause in 91% of cases. About 56% had one germ, and 35% had two or more. The most common were Salmonella (22%), rotavirus (18%), norovirus (17%), and C. difficile (17%). These findings helped guide antibiotic decisions. Antibiotics were started in 41% of bacterial cases and stopped in 39% of viral cases. That’s a meaningful shift toward more targeted care.

Doctors also looked at white blood cell counts and inflammation markers. Higher markers were more common in bacterial infections. Length of hospital stay, however, did not differ much by germ type. This suggests the test helps most with choosing the right treatment, not necessarily shortening the stay.

Experts say the test is a strong tool, but it works best when paired with clinical judgment. Some germs can live in the gut without causing illness, especially in young children. That means a positive result doesn’t always prove the germ is the main problem. Conventional stool cultures still have a role for certain bacteria and to check which antibiotics will work.

For families, this means a clearer path to treatment. If your child has severe vomiting and diarrhea, ask your doctor whether a rapid stool test is available. It can help avoid unnecessary antibiotics and ensure the right ones are used when needed. It may also reduce the time spent waiting for answers.

The study has limits. It was done at one hospital, and it looked back at records rather than testing a new treatment. Not every hospital has this test yet, and costs and access can vary. Larger studies in different settings will help confirm the benefits.

What happens next? Researchers will likely test this approach in more hospitals and in different countries. Health systems may consider adopting the test more widely to support antibiotic stewardship. If you’re a parent or caregiver, talk to your child’s doctor about whether this test makes sense for your situation.

Study Details

Study typeCohort
EvidenceLevel 3
PublishedApr 2026
View Original Abstract ↓
IntroductionAcute gastroenteritis (AGE) is a major cause of childhood morbidity and mortality worldwide, yet pathogen identification often remains elusive. Gastrointestinal (GI) multiplex polymerase chain reaction (PCR) enables simultaneous detection of multiple enteropathogens with greater accuracy and faster turnaround than conventional methods. This study aimed to assess the diagnostic and clinical impact of GI multiplex PCR testing on pediatric gastroenteritis at a tertiary care hospital in Saudi Arabia.MethodsA retrospective observational study was conducted at King Abdullah Specialized Children's Hospital, Riyadh, including all children aged ≤14 years admitted with gastroenteritis who underwent GI multiplex PCR testing between January 2022 and December 2024. Clinical data, laboratory results, and management outcomes were retrieved from electronic medical records. Stool samples were analyzed using the BioFire FilmArray GI panel, with stool culture and ova/parasite testing performed as indicated.ResultsA total of 276 children were included, with infants aged 1–23 months comprising the largest subgroup (43.5%). GI multiplex PCR was positive in 90.9% of cases, with single-pathogen detections in 56.2% and co-detections in 34.8%. The most common pathogens were Salmonella (22.1%), Rotavirus A (18.1%), Norovirus (17.4%), and Clostridium difficile (17.0%). Antibiotic use differed by pathogen type, being lower in viral infections (27.4%) and higher in bacterial infections (45.3%). Following PCR results, antibiotics were initiated in 41.3% of bacterial cases and discontinued in 39.4% of viral cases. Detection of bacterial pathogens and abnormal white blood cell count were independently associated with antibiotic use. Inflammatory markers, particularly ESR, were higher in bacterial infections, while length of hospital stay did not differ significantly by pathogen type.ConclusionGI multiplex PCR demonstrated high diagnostic yield and was associated with differences in antibiotic use according to pathogen type, suggesting a potential role in informing targeted therapy and antimicrobial stewardship in pediatric AGE. However, interpretation requires clinical correlation, particularly in cases of co-detection and pathogens with known asymptomatic carriage. Conventional stool culture remains complementary for bacterial isolation and susceptibility testing.
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