Analysis of the Current Situation of Common Gastrointestinal Pathogens in the Central Medical Center

中部醫學中心常見胃腸道感染病原體的現況分析

腹瀉病常是患者因腸胃道問題導致到急診就診和住院的主要原因，最常見的原因為腸胃道感染，可能是病毒、細菌或寄生蟲感染所引起；另外也可能是全身性感染所表現的臨床症狀。而非感染性的原因則可能包含發炎性腸道疾病、大腸激躁症、急性中毒、乳糖不耐症與藥物等因素。目前臨床上在鑑定胃腸道感染的病原體，以傳統的實驗室培養方法通常會較耗時，且檢出率也相對較低。根據先前國外meta-analysis回顧分析研究，與傳統糞便培養的20%陽性檢出率相比，利用PCR檢測的方法可顯著提高其診斷率，但是類似的研究在臺灣是較少被探討的。因此本篇研究統計自2020年七月到2022年七月兩年間，在中山醫學大學附設醫院就診的患者，利用BioFire FilmArray胃腸道檢測套組執行檢測的結果，來進一步分析胃腸道感染性病例的病因。結果發現診斷的陽性率可提高到52.09 %，其中在兒童急診患者的檢出率最高，為78.11%，其次是成人急診患者，檢出率為66.67 %；最常檢測出的病原體前五名分別為沙門氏菌(Salmonella)、腸病原性大腸桿菌 (Enteropathogenic Escherichia coli；EPEC)、困難梭狀桿菌 (Clostridium difficile toxin A/B)、曲狀桿菌 (Campylobacter) 與諾羅病毒 (Norovirus GI/GII)，而且結果也顯示某些病原體也會有季節性表現的趨勢，同時在不同科別與不同年齡層會有不同的病原體感染分布情況。因此，利用BioFire FilmArray胃腸道檢測套組來篩檢或監測腸胃道疾病的患者，不僅能縮短檢測的時間，也能提供給醫師較全面的病原體檢測結果，作為臨床上患者診斷的參考與及時的臨床治療及處置。

Diarrhea is often the main reason for gastrointestinal problems leading to emergency department visits and hospitalizations. The most common cause is gastrointestinal infection, which may be caused by viral, bacterial, or parasitic infection; it may also be clinical symptoms of systemic infection. Non-infectious causes may include inflammatory bowel disease, irritable bowel syndrome, acute poisoning, lactose intolerance, and medications. At present, the identification of pathogens of gastrointestinal infections in clinical practice is usually time-consuming with traditional laboratory culture methods, and the detection rate is relatively low. According to previous meta-analysis retrospective analysis, compared with the 20% positive detection rate of stool culture, detection by PCR can significantly improve its diagnostic rate, but similar studies have been less explored in Taiwan. Therefore, this study counted the patients who received medical treatment in the Chung Shan Medical University Hospital from July 2020 to July 2022, and results from tests performed with the BioFire FilmArray Gastrointestinal Panel were used to further analyze the etiology of gastrointestinal infections. The results showed that the positive rate of diagnosis could be increased to 52.09 %, among which the detection rate was the highest in pediatric emergency patients with a detection rate of 78.11 %, followed by adult emergency patients with a detection rate of 66.67 %; the top five most frequently detected pathogens were respectively Salmonella, Enteropathogenic Escherichia coli (EPEC), Clostridium difficile toxin A/B, Campylobacter and Norovirus GI/GII, and the results also showed that some pathogens also have a seasonal trend, and there were different distributions of pathogen infections in different departments and different age groups. Therefore, using the BioFire FilmArray Gastrointestinal Panel to screen or monitor patients with gastrointestinal diseases can not only shorten the detection time, but also provide physicians with more comprehensive pathogen detection results, which can be used as a reference for clinical patient diagnosis and timely clinical treatment and management.