{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T21:27:15Z","timestamp":1788470835818,"version":"build-2803163510"},"reference-count":37,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2021,4,30]],"date-time":"2021-04-30T00:00:00Z","timestamp":1619740800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100016739","name":"BioFire DIagnostics","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100016739","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>Acute gastrointestinal infection (AGI) represents a significant public health concern. To control and treat AGI, it is critical to quickly and accurately identify its causes. The use of novel multiplex molecular assays for pathogen detection and identification provides a unique opportunity to improve pathogen detection, and better understand risk factors and burden associated with AGI in the community. In this study, de-identified results from BioFire<jats:sup>\u00ae<\/jats:sup> FilmArray<jats:sup>\u00ae<\/jats:sup> Gastrointestinal (GI) Panel were obtained from January 01, 2016 to October 31, 2018 through BioFire<jats:sup>\u00ae<\/jats:sup> Syndromic Trends (Trend), a cloud database. Data was analyzed to describe the occurrence of pathogens causing AGI across United States sites and the relative rankings of pathogens monitored by FoodNet, a CDC surveillance system were compared. During the period of the study, the number of tests performed increased 10-fold and overall, 42.6% were positive for one or more pathogens. Seventy percent of the detections were bacteria, 25% viruses, and 4% parasites. <jats:italic>Clostridium difficile<\/jats:italic>, enteropathogenic <jats:italic>Escherichia coli<\/jats:italic> (EPEC) and norovirus were the most frequently detected pathogens. Seasonality was observed for several pathogens including astrovirus, rotavirus, and norovirus, EPEC, and <jats:italic>Campylobacter<\/jats:italic>. The co-detection rate was 10.2%. Enterotoxigenic <jats:italic>E<\/jats:italic>. <jats:italic>coli<\/jats:italic> (ETEC), <jats:italic>Plesiomonas shigelloides<\/jats:italic>, enteroaggregative <jats:italic>E<\/jats:italic>. <jats:italic>coli<\/jats:italic> (EAEC), and <jats:italic>Entamoeba histolytica<\/jats:italic> were detected with another pathogen over 60% of the time, while less than 30% of <jats:italic>C<\/jats:italic>. <jats:italic>difficile<\/jats:italic> and <jats:italic>Cyclospora cayetanensis<\/jats:italic> were detected with another pathogen. Positive correlations among co-detections were found between <jats:italic>Shigella<\/jats:italic>\/Enteroinvasive <jats:italic>E<\/jats:italic>. <jats:italic>coli<\/jats:italic> with <jats:italic>E<\/jats:italic>. <jats:italic>histolytica<\/jats:italic>, and ETEC with EAEC. Overall, the relative ranking of detections for the eight GI pathogens monitored by FoodNet and BioFire Trend were similar for five of them. AGI data from BioFire Trend is available in near real-time and represents a rich data source for the study of disease burden and GI pathogen circulation in the community, especially for those pathogens not often targeted by surveillance.<\/jats:p>","DOI":"10.1371\/journal.pone.0250767","type":"journal-article","created":{"date-parts":[[2021,4,30]],"date-time":"2021-04-30T17:34:34Z","timestamp":1619804074000},"page":"e0250767","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":20,"title":["Real-time gastrointestinal infection surveillance through a cloud-based network of clinical laboratories"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2309-4447","authenticated-orcid":true,"given":"Juliana M.","family":"Ruzante","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine","family":"Olin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Breda","family":"Munoz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeff","family":"Nawrocki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rangaraj","family":"Selvarangan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindsay","family":"Meyers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,4,30]]},"reference":[{"key":"pone.0250767.ref001","doi-asserted-by":"crossref","first-page":"97","DOI":"10.2147\/CEG.S6554","article-title":"Acute gastroenteritis: from guidelines to real life.","volume":"3","author":"CM Chow","year":"2010","journal-title":"Clin Exp Gastroenterol"},{"key":"pone.0250767.ref002","doi-asserted-by":"crossref","first-page":"16","DOI":"10.3201\/eid1701.P21101","article-title":"Foodborne illness acquired in the United States\u2014unspecified agents","volume":"17","author":"E Scallan","year":"2011","journal-title":"Emerg Infect Dis"},{"key":"pone.0250767.ref003","unstructured":"The Center for Disease Control and Prevention (CDC). 2015 [cited 30 April 2019]. In: FoodNet surveillance [Internet]. [about 2 screens]. Available from: https:\/\/www.cdc.gov\/foodnet\/surveillance.html"},{"key":"pone.0250767.ref004","first-page":"e01457","article-title":"A Gastrointestinal PCR Panel improves clinical management and lowers health care costs","volume":"56","author":"SG Beal","year":"2017","journal-title":"J Clin Microbiol"},{"key":"pone.0250767.ref005","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1016\/j.diagmicrobio.2014.08.001","article-title":"Culture-independent diagnostic testing: have we opened Pandora\u2019s box for good","volume":"80","author":"JM Janda","year":"2014","journal-title":"Diagn Microbiol Infect Dis"},{"key":"pone.0250767.ref006","doi-asserted-by":"crossref","first-page":"1305","DOI":"10.3201\/eid1908.130482","article-title":"Acute gastroenteritis surveillance through the National Outbreak Reporting System, United States","volume":"19","author":"AJ Hall","year":"2013","journal-title":"Emerg Infect Dis"},{"key":"pone.0250767.ref007","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1128\/JCM.01624-16","article-title":"Clinical microbiology laboratories\u2019 adoption of culture-independent diagnostic tests is a threat to foodborne-disease surveillance in the United States","volume":"55","author":"S Shea","year":"2016","journal-title":"J Clin Microbiol"},{"key":"pone.0250767.ref008","doi-asserted-by":"crossref","first-page":"2479","DOI":"10.1128\/JCM.00253-13","article-title":"A challenge and an opportunity to improve patient management and public health surveillance for food-borne infections through culture-independent diagnostics","volume":"51","author":"R Atkinson","year":"2013","journal-title":"J Clin Microbiol"},{"key":"pone.0250767.ref009","doi-asserted-by":"crossref","first-page":"S432","DOI":"10.1093\/cid\/cis267","article-title":"Impacts of culture-independent diagnostic practices on public health surveillance for bacterial enteric pathogens","volume":"54","author":"AB Cronquist","year":"2012","journal-title":"Clin Infect Dis"},{"key":"pone.0250767.ref010","doi-asserted-by":"crossref","first-page":"3909","DOI":"10.1128\/JCM.02238-13","article-title":"Implications of culture-independent panel-based detection of Cyclospora cayetanensis","volume":"51","author":"SN Buss","year":"2013","journal-title":"J Clin Microbiol"},{"key":"pone.0250767.ref011","doi-asserted-by":"crossref","first-page":"179.e9","DOI":"10.1016\/j.cmi.2014.07.011","article-title":"How well does physician selection of microbiologic tests identify Clostridium difficile and other pathogens in paediatric diarrhoea? 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Available from: https:\/\/syndromictrends.com\/info\/main"},{"key":"pone.0250767.ref015","doi-asserted-by":"crossref","first-page":"e59","DOI":"10.2196\/publichealth.9876","article-title":"Automated real-time collection of pathogen-specific diagnostic data: Syndromic infectious disease epidemiology","volume":"4","author":"L Meyers","year":"2018","journal-title":"JMIR Public Health Surveill"},{"key":"pone.0250767.ref016","unstructured":"US Department of Health and Human Services. Title 45. 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In: NoroSTAT data [Internet]. [about 2 screens]. Available from: https:\/\/www.cdc.gov\/norovirus\/reporting\/norostat\/data.html"},{"key":"pone.0250767.ref028","doi-asserted-by":"crossref","first-page":"1048","DOI":"10.1128\/CMR.00013-14","article-title":"Human astrovirus","volume":"27","author":"A Bosh","year":"2014","journal-title":"Clin Microbiol Rev"},{"key":"pone.0250767.ref029","unstructured":"The Center for Disease Control and Prevention (CDC). 2018 [cited 1 May 2019]. In: Rotavirus in the U.S. [Internet]. [about 2 screens]. Available from: https:\/\/www.cdc.gov\/rotavirus\/surveillance.html"},{"key":"pone.0250767.ref030","doi-asserted-by":"crossref","first-page":"1624","DOI":"10.1093\/cid\/cix624","article-title":"Increasing Campylobacter infections, outbreaks, and antimicrobial resistance in the United States, 2004\u20132012","volume":"65","author":"AL Geissler","year":"2017","journal-title":"Clin Infect Dis"},{"key":"pone.0250767.ref031","doi-asserted-by":"crossref","first-page":"822","DOI":"10.1128\/CMR.00022-13","article-title":"Recent advances in understanding Enteric Pathogenic Escherichia coli","volume":"26","author":"MA Croxen","year":"2013","journal-title":"Clin Microbiol Rev"},{"key":"pone.0250767.ref032","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1128\/CMR.00103-15","article-title":"Plesiomonas shigelloides revisited","volume":"29","author":"JM Janda","year":"2016","journal-title":"Clin Microbiol Rev"},{"key":"pone.0250767.ref033","doi-asserted-by":"crossref","first-page":"568","DOI":"10.15585\/mmwr.mm6825a3","article-title":"Cryptosporidiosis outbreaks\u2014United States, 2009\u20132017","volume":"68","author":"R Gharpure","year":"2019","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"pone.0250767.ref034","unstructured":"Board of Scientific Counselors, Office of Infectious Diseases, Food Safety Modernization Act Surveillance Working Group. Annual report to the secretary, Department of Health and Human Services. 2017. Available from https:\/\/www.cdc.gov\/ddid\/docs\/BSC-OID-FSMA-SurvWG-2017-AnnualReport-508.pdf."},{"key":"pone.0250767.ref035","doi-asserted-by":"crossref","first-page":"2326","DOI":"10.1128\/AAC.02176-12","article-title":"Meta-analysis of antibiotics and the risk of community-associated Clostridium difficile infection","volume":"57","author":"KA Brown","year":"2013","journal-title":"Antimicrob Agents Chemother"},{"key":"pone.0250767.ref036","unstructured":"The Center for Disease Control and Prevention (CDC). 2018 [cited 1 May 2019]. In: Cyclosporiasis outbreaks investigations\u2013United States, 2017 [Internet]. [about 4 screens]. 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