An interventional study of Filmarray PCR multiplex-PCT assay in Acute Diarrhea and Acute Colitis of Presumed Infectious Origin, sponsored by Assistance Publique - Hôpitaux de Paris. Completed at 1 site in France. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2022-01-25.
Sponsored by Assistance Publique - Hôpitaux de Paris · Not applicable, Interventional, and Diagnostic
Acute diarrhea and acute colitis of infectious origin are common reasons for consultation at the emergency department. The current etiological diagnostic approach is limited to the determination of markers of inflammation, such as CRP and blood leukocytes, which lack specificity and sensitivity for bacterial infection. The stool culture can detect bacterial pathogens in the stool with a result at least 48 hours later and a positivity rate \<50%.
This study will describe the procalcitonin (PCT) concentrations (a biomarker of bacterial infection) in this population to evaluate its usefulness depending on the viral or bacterial etiology identified by stool multiplex gastro-intestinal PCR panel (GI panel) and stool culture.
The investigators hypothesize that PCT levels will be higher if the GI panel or the stool culture identifies a bacteria or a parasite, as it is the case in respiratory tract infections. If there is a detection of a virus by the GI panel or both the stool culture and the GI panel are negative, the investigators expect that PCT values will be lower or negative.
the investigators will include the patients admitted to the ED with a suspicion of infectious diarrhea or acute colitis in order to have a large representative panel of infectious diarrhea etiologies.
Only the patients having a blood sample prescribed as the routine care will be included. The blood sample is useful for dosing CRP and whole blood cell count (WBC), which are part of current biologic analyses performed in this context. After getting the patient's consent, the investigator will add the PCT dosage in blood sampling and will ask the patient to provide a stool sample, in order to have a stool culture and to perform an extended investigation for the pathogens through multiplex PCR technology (Filmarray ®GI panel).
The physician will be asked if all these results (the ones ordered currently together with the dosage of PCT and the GI panel) will change his/her decision to start an antibiotic.
Patients will receive a phone call at day 15 after their initial admission in the emergency department and will be asked if he/she has consulted a new physician or if a new treatment by antibiotics was started.
Data collection procedures: Data from the medical file will be collected by the investigators and the emergency department clinical research assistant. All the data will be pseudonymized. The collection will be done at the day of admission in the emergency department and after the phone interview at Day15.
Acute diarrhea and acute colitis of infectious origin are common reasons for consultation at the emergency department. The current etiological diagnostic approach is limited to the determination of markers of inflammation, such as CRP and blood leukocytes, which lack specificity and sensitivity for bacterial infection. The stool culture can detect bacterial pathogens in the stool with a result at least 48 hours later and a positivity rate \<50%.
This study will describe the procalcitonin (PCT) concentrations (a biomarker of bacterial infection) in this population to evaluate its usefulness depending on the viral or bacterial etiology identified by stool multiplex gastro-intestinal PCR panel (GI panel) and stool culture.
The investigators hypothesize that PCT levels will be higher if the GI panel or the stool culture identifies a bacteria or a parasite, as it is the case in respiratory tract infections. If there is a detection of a virus by the GI panel or both the stool culture and the GI panel are negative, the investigators expect that PCT values will be lower or negative.
The investigators will include the patients admitted to the ED with a suspicion of infectious diarrhea or acute colitis in order to have a large representative panel of infectious diarrhea etiologies.
Only the patients having a blood sample prescribed as the routine care will be included. The blood sample is useful for dosing CRP and whole blood cell count (WBC), which are part of current biologic analyses performed in this context. After getting the patient's consent, the investigator will add the PCT dosage in blood sampling and will ask the patient to provide a stool sample, in order to have a stool culture and to perform an extended investigation for the pathogens through multiplex PCR technology (Filmarray ®GI panel).
The physician will be asked if all these results (the ones ordered currently together with the dosage of PCT and the GI panel) will change his/her decision to start an antibiotic.
Patients will receive a phone call at day 15 after their initial admission in the emergency department and will be asked if he/she has consulted a new physician or if a new treatment by antibiotics was started.
Data collection procedures: Data from the medical file will be collected by the investigators and the emergency department clinical research assistant. All the data will be pseudonymized. The collection will be done at the day of admission in the emergency department and after the phone interview at Day15.
Statistical justification for sample size: This will be a pilot study to describe the results of PCT concentration and multiplex GI panel. As to our knowledge, there is no published study reporting PCT concentrations in this population. This preclude a sample, size calculation. The investigators will include as much patients as possible during one year in order to cover the epidemiological seasonal variations and to obtain a convenient sample of at least 100 patients.
Statistical methods description: Clinical and biological data will be reported as median and interquartile range or mean +/- SD. PCT values will be reported as median and IQR, respectively if a there is a viral infection, a documented infection (bacterium or parasite) or no pathogen identified by GI panel and/or stool culture (bacteria). Patient's characteristics and PCT results will be compared in all groups, using as a reference, the group where no pathogen is observed. A sub-group analysis will be performed on colitis and acute diarrhea respectively, to find out if there is any difference with the variables analyzed as both pathologies are not managed in the same way.
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Inclusion criteria for patients presenting an acute diarrhoea :
Inclusion criteria for patients presenting an infectious colitis :
Attending the emergency department for a documented colitis presumed to be of infectious origin, for whom a blood test in the emergency department is planned, defined by:
Exclusion Criteria:
Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.
You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.
Informed consent
Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.
You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Device: Filmarray PCR multiplex-PCT assay
Filmarray PCR multiplex gastro intestinal panel on stools and serum PCT dosage
PCT concentration according to each type of pathogens identified using GI panel and stool cultures (bacteria, virus, parasites).
The median PCT concentration will be reported in the three main etiological group (viruses, bacteria, parasites) identified by stool culture and GI panel
Time frame: Day 1
Positivity rate and distribution of pathogens identified by the GI panel and stool culture
Positivity Rate of GI Panel and stool culture given in percentage (%) and the distribution of pathogens found if positive, divided in 3 groups (virus, bacteria and parasites)
Time frame: Day 1
Rate of antibiotic therapy initiated in the ER and in the first following 15 days
Rate of antibiotics use given in percentage (%)
Time frame: Day 1 and 15
Number of days of antibiotic exposure at day 15
Number of days on antibiotics for each patient
Time frame: Day 15
Rate of antibiotics prescription before and after results of the GI panel and PCT (Day 1)
Rate (%) of intention to start an antibiotic before the results of the GI panel and rate (%) of antibiotic's prescription after the results of the GI panel and PCT
Time frame: Day 1
Plan to share: No
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Ran from Mar 2020 to primary completion in Mar 2020, 0 months.
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