870 infection control & hospital epidemiology july 2018, vol. 39, no. 7
was highlighted in a small report from Netherlands, in which 11 of 43 additional positives using xTAG GPP could not be confirmed, including 5 EH and 4 Salmonella cases.8 These results, coupled with those of our study, support the need for confirmatory testing in epidemiologically implausible circumstances. A large health-system analysis of GPP imple- mentation noted the large number of positive results of uncertain clinical significance as the main detraction to wide- scale implementation of these testing strategies, while others have identified GPP use in hospitalized patients as a potential diagnostic stewardship target.9,10 In summary, clusters of a single pathogen identified by
multiplex GPP diagnostic assay require investigation to confirm the likelihood of a true outbreak, especially in the absence of convincing epidemiologic data for exposure to the identified pathogen. Further evaluation of GPP diagnostic assays is necessary to document the true sensitivity and specificity of these multiplex assays in real-world clinical settings, especially among specialized patient populations.
acknowledgments
Financial support: The Memorial Sloan Kettering Cancer Center supported this study (Core grant no. P30 CA008748). Potential conflicts of interest: Dr. Babady acknowledges grant support
from Luminex. All authors report no conflicts of interest relevant to this article.
Affiliations: 1. Infectious Diseases, Department of Medicine, Memorial
Sloan Kettering Cancer Center, New York, New York; 2. Infection Control, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; 3. Clinical Microbiology Service, Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; 4. Department of Medicine, Weill Cornell Medical College, New York, New York. Address correspondence to Elizabeth Robilotti, MD, MPH, 1275 York Avenue Box 9, New York, NY 10065 (
robilote@mskcc.org).
Received January 24, 2018; accepted March 28, 2018; electronically published May 10, 2018 © 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 0899-823X/2018/3907-0016. DOI: 10.1017/ice.2018.95
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