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Gastro-intestinal infections

Noah Fongwen updates on resistance trends in pathogens causing gastro-intestinal infections (GIs) and advances in the laboratory diagnosis of of GIs.
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SPEAKER: In this section on gastrointestinal infections, we’ll look at the proportion of patients with gastrointestinal infections caused by resistant Salmonella species and the proportion of patients with gastrointestinal infections caused by resistant Shigella. And we’ll also talk about the diagnosis of gastrointestinal infections, giving some key updates.
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This slide shows the proportion of patients with gastrointestinal infections caused by resistant Salmonella species. We see that for widely available antibiotics like ciprofloxacin and levofloxacin, the resistance is already high. And for cephalosporins like ceftriaxone, ceftazidime, and cefotaxime, the resistance is also high, and it’s on the rise. And there are reported cases of resistance for meropenem, imipenem, and ertapenem. This slide shows the proportion of patients with gastrointestinal infections caused by resistant Shigella species. Unlike the case of Salmonella, the resistance to cefriaxone and cefotaxime is already very high. And the proportion of patients with GI infections caused by resistant Shigella to ceftriaxone and to cefotaxime is way above 10%.
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And even though that for ceftazadime is less than 10%, it is on the rise. We see that there is widespread resistance to ciprofloxacin, levofloxacin, and azithromycin.
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In terms of diagnosis of gastrointestinal infections, the latest molecular multiplex panels for diagnosis of diarrheal diseases include the FilmArray Gastrointestinal Panel, the Verigene Enteric Pathogen Test, the xTAG Gastrointestinal Pathogen Panel, and the BD MAX. The BD MAX has four separate panels for gastrointestinal pathogens– the enteric bacteria panel, the extended enteric bacteria panel, the enteric parasite panel, and enteric viral panel. Conventional methods for diarrhoea or pathogen detection include microscopic examination, culture, and ELISA. Microscopic examination requires specific expertise, and the results are operator dependent. Stool culture is labour intensive and takes two to three days to result. ELSIA assays are generally less sensitive than PCR.
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