Akut Gastroenterit Tanısında Multiplex PCR Paneli ve Konvansiyonel Yöntemlerin Karşılaştırılması

Abstract

Amaç:Akut gastroenterit (AGE), özellikle beş yaş altı çocuklar, yaşlı bireyler ve immün yetmezliği olan hastalar arasında önemli bir küresel sağlık yükü olmaya devam etmektedir. Etken patojenlerin hızlı ve doğru biçimde tanımlanması, uygun klinik yönetim açısından büyük önem taşımaktadır. Multipleks PCR panelleri, konvansiyonel tanı yöntemlerine umut verici bir alternatif olarak öne çıkmaktadır. Bu çalışmada, AGE semptomları ile başvuran hastalarda QIAstat-Dx Gastrointestinal Paneli ile saptanan enterik patojenlerin dağılımının değerlendirilmesi ve geleneksel yöntemlerle tanısal performansının karşılaştırılması amaçlanmıştır. Yöntemler: Ağustos 2021 - Mart 2025 tarihleri arasında gastrointestinal semptomlarla başvuran 177 hastadan alınan dışkı örnekleri üzerinde retrospektif bir çalışma yürütülmüştür. Bakteriyel, viral ve parazitik patojenlerin tespiti amacıyla QIAstat-Dx Gastrointestinal Paneli uygulanmıştır. Sonuçlar, eş zamanlı olarak mevcut olan kültür, antijen testleri ve ELISA yöntemleriyle karşılaştırılmıştır. Bulgular: Hastaların 65'inde (%36,7) en az bir patojen saptanmış ve toplamda 79 mikrobiyal hedef tespit edilmiştir. İkili veya daha fazla etken içeren ko-enfeksiyon 12 hastada (%18,5) gözlemlenmiştir. En sık saptanan bakteriyel etkenler sırasıyla enteropatojenik Escherichia coli (n=15), Campylobacter spp. (n=9), enteroagregatif E. coli (n=8) ve Salmonella spp. (n=7) olmuştur. Viral patojenler arasında norovirüs (n=8) ve rotavirüs (n=6) ön plana çıkarken, parazitik etkenler arasında Cryptosporidium spp. (n=4) ve Giardia lamblia (n=3) en sık saptananlardır. Konvansiyonel yöntemlerle karşılaştırıldığında, PCR'ın saptama oranları Salmonella spp. için %85, rotavirüs için %66 ve Clostridioides difficile için %42 olarak belirlenmiştir. Yaşa göre yapılan analizde, 18 yaş altı hastalarda rotavirüsün baskın patojen olduğu; 65 yaş ve üzerindeki hastalarda ise Campylobacter spp., C. difficile ve EPEC'in ön plana çıktığı görülmüştür. Yoğun bakım hastalarındaki patojen pozitiflik oranı %52 olup genel kohort oranı olan %36,7'nin üzerinde saptanmıştır. Sonuç: QIAstat-Dx Gastrointestinal Paneli, konvansiyonel tanı yöntemleriyle kıyaslandığında daha yüksek duyarlılık ve daha kısa sonuç süresi sunmuş; özellikle ko-enfeksiyonların ve kültürle tanımlanamayan patojenlerin tespitinde belirgin avantaj sağlamıştır. Bununla birlikte, PCR pozitif sonuçların klinik önemi ve rutin panel kullanımının maliyet etkinliği hâlâ tartışmalıdır. Multipleks PCR testinin, hızlı ve kapsamlı patojen tanımlamasının klinik olarak gerekli olduğu seçilmiş vakalarda uygulanması en uygun yaklaşım olarak değerlendirilmektedir.

Keywords

• akut gastroenterit
• multipleks PCR paneli
• konvansiyonel yöntemler

Comparison of multiplex PCR panel and conventional methods in the diagnosis of acute gastroenteritis

Abstract

Acute gastroenteritis (AGE) remains a significant global health burden, particularly among children under five years of age, elderly individuals, and immunocompromised patients. Rapid and accurate identification of causative pathogens is essential for appropriate clinical management. Multiplex PCR panels have emerged as a promising alternative to conventional diagnostic methods. This study aimed to evaluate the distribution of enteric pathogens detected by the QIAstat-Dx Gastrointestinal Panel in patients presenting with AGE symptoms and to compare its diagnostic performance with traditional methods. A retrospective study was conducted on stool samples from 177 patients presenting with gastrointestinal symptoms between August 2021 and March 2025. The QIAstat-Dx Gastrointestinal Panel (Qiagen, Hilden, Germany) was applied to detect bacterial, viral, and parasitic pathogens. Results were compared with those obtained by culture, antigen-based assays, and ELISA where concurrently available. At least one pathogen was identified in 65 patients (36.7%), with a total of 79 microbial targets detected. Co-infections involving two or more pathogens were observed in 12 patients (18.5%). The most frequently detected bacterial agents were enteropathogenic Escherichia coli (n=15), Campylobacter spp. (n=9), Enteroaggregative E. coli (n=8), and Salmonella spp. (n=7). Among viral pathogens, norovirus (n=8) and rotavirus (n=6) predominated, while Cryptosporidium spp. (n=4) and Giardia lamblia (n=3) were the most common parasitic agents. When compared with conventional methods, the concordance or confirmation rates of PCR findings were 85.7% for Salmonella spp., 100% for rotavirus antigen tests, and 42.8% for Clostridioides difficile toxin assays. Age-stratified analysis revealed rotavirus as the predominant pathogen in patients under 18 years, whereas Campylobacter spp., C. difficile, and EPEC were most frequently identified in patients aged 65 years and older. The pathogen positivity rate among ICU patients was 52%, exceeding the overall cohort rate of 36.7%. The QIAstat-Dx Gastrointestinal Panel demonstrated superior sensitivity and shorter turnaround time compared to conventional diagnostic methods, with particular advantages in detecting co-infections and pathogens not identifiable by culture alone. However, the clinical significance of PCR-positive results and the cost-effectiveness of routine panel use remain uncertain. Selective use of multiplex PCR testing remains the most prudent approach when rapid pathogen identification is clinically warranted

Keywords

• acute gastroenteritis
• multiplex PCR panel
• conventional methods

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