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Healthcare-associated infection (HAI) pathogens
Cepheid

Cepheid

Editorial Team

6m Read

September 09, 2026

COMMUNITY AND GLOBAL HEALTH

Article

What E. coli Co-Detections Reveal About Interpreting Multiplex GI Panel Results

Researchers analyzing multiplex gastrointestinal (GI) panel results found that multiple E. coli pathotypes were frequently detected alongside other enteric pathogens, potentially complicating data interpretation.

The findings were presented at the Association for Diagnostics & Laboratory Medicine (ADLM) 2026 Clinical Lab Expo.

Key Takeaways

  • E. coli EPEC was the third most prevalent pathogen (7.8%) after Clostridioides difficile (17.4%) and Norovirus (11.7%) in the GI panel health record data
  • E. coli co-detection was common: 14% of E. coli-positive encounters were multi-pathotype
  • Among EPEC-positive cases, norovirus, EAEC, ETEC, Campylobacter spp., and C. difficile were the most frequent co-detections.
  • Among EAEC- and ETEC-positive cases, other E. coli pathotypes were among the most common co-detected organisms.

 

 

Study Summary

This retrospective analysis used Truveta electronic health record data (53,757 encounters) to evaluate patients tested with multiplex GI panels in acute care settings, including emergency departments and inpatient units. Researchers identified panels using CPT and LOINC codes, then assessed the five most frequent pathogens co-detected with EPEC, EAEC, and ETEC. Co-detection was defined as two or more pathogens reported on a single panel, with prevalence calculated among patients tested for both organisms. The analysis found that E. coli pathotypes were commonly detected with viral and bacterial pathogens. This co-detection can complicate interpretation and may influence inappropriate antibiotic prescribing, especially when the pathogenic role of E. coli is unclear.

Top 5 co-detections per pathotype chart

The Challenge

Multiplex GI panels can rapidly detect a broad range of organisms, but broad detection can also introduce interpretation challenges. This is especially true when organisms such as EPEC or EAEC may represent colonization rather than the primary cause of symptoms. When these findings appear alongside viral pathogens or other bacteria, clinicians may face uncertainty about which result is clinically actionable.

The Insight

"Detection alone does not always identify the causative pathogen,” said lead study author, Anita Mohandas. “When E. coli pathotypes are found alongside viral or bacterial organisms, clinical context becomes essential for determining whether treatment is warranted."

Conclusion

This study underscores a practical challenge in syndromic GI testing: more detection does not always mean clearer clinical direction. Frequent E. coli co-detections, particularly with viral pathogens, highlight the need for careful interpretation, clinician education, and panel design that prioritizes clinically actionable results.

Abbreviations

EPEC enteropathogenic E. coli; EAEC enteroaggregative E. coli; ETEC enterotoxigenic E. coli; DEC diarrheagenic E. coli; CPT Current Procedural Terminology; LOINC Logical Observation Identifiers Names and Codes

Want to know more?

View the poster 

Prevalence of Co-Detection with E. coli Subtypes in Multiplex Gastrointestinal Panels

Authors: Anita Mohandas, MSc, MHPª; Riley Zambrano, MScª; Jordan Chase, BAª; Christophe Martinaud, MD, PhDª
ªCepheid, Sunnyvale, CA, USA

ADLM 2026. Poster A-305

The content presented on this page is intended for informational and educational purposes. While it is available globally, it may reflect clinical practices or healthcare system considerations specific to a particular region.

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