Mapping the Literature on the Impact of Gastrointestinal Multiplexed Pathogen Panels on Clinical and Healthcare Utilization Outcomes: A Scoping Review

BACKGROUND: Gastrointestinal pathogen multiplex panels (GPPs) can test a single stool specimen for multiple pathogen targets in less than 5 h with some as little as 1 h. Although GPPs have demonstrated rapid and sensitive detection, their increased cost and unclear reimbursement structures have put into question their value and role in the cost-effective management of patients with gastrointestinal infections. We performed a scoping review to identify and systematically map the existing literature regarding the impact of GPPs on immediate, proximal, and distal clinical and healthcare utilization outcomes across healthcare settings. METHODS: Databases were searched from inception until November 22, 2022. Full research articles in English were eligible for inclusion if they included a multiplexed (≥3 targets) nucleic acid amplification testing method and conventional microbiology comparator method performed on clinical samples. RESULTS: A total of 6027 potential studies were identified. Following title and abstract screening and full article review, 175 studies were included. The most frequently studied GPPs were laboratory-developed tests (LDTs) (34.9%) and the Biofire® FilmArray® Gastrointestinal Panel (22.3%). The majority of these studies were conducted in the inpatient (37.1%), outpatient (28.0%), and emergency department (ED) (14.0%) settings. The most frequently reported outcomes included diagnostic accuracy (69.7%), organism detection (59%), time to diagnosis (12.6%), and antibiotic changes (8.6%). CONCLUSION: We identified a paucity of research reporting on proximal and distal outcomes associated with GPP use. Our review highlights the critical need for well-designed studies focusing on downstream clinical and healthcare utilization outcomes to guide meaningful and cost-effective incorporation of GPPs into diagnostic work flows.