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Editorial Team

6m Read

June 02, 2026

COMMUNITY AND GLOBAL HEALTH

Article

Why the Xpert® GI Panel Targets Matter for Clinical Decision-Making

When a patient presents with acute gastrointestinal symptoms, the most important question isn’t “How many pathogens can we detect?” It’s “Will this result change what we do next?”

That principle guided the design of the Xpert® GI Panel. The panel prioritizes pathogens whose detection directly informs clinical decisions, infection control, antimicrobial stewardship, and public health action.

 

This article explains:

  • Why each target was selected
  • What was intentionally left out
  • How this approach supports high-value testing in community and outpatient settings

Acute GI Infections: Why Target Selection Matters

Acute gastrointestinal infection (AGI) is a common reason patients seek medical care, particularly in emergency departments and outpatient settings.1,2 Symptoms such as diarrhea, vomiting, nausea, and abdominal pain are non-specific,3,4 and without identifying the causative organism, management may default to empiric antibiotics, unnecessary isolation, or additional diagnostic testing that does not always improve patient outcomes.3,5

Identifying the right pathogens early can:6,7

✓   Guide appropriate therapy

✓   Support infection prevention and control

✓   Enable public health reporting when needed

✓   Help avoid unnecessary antibiotics or invasive procedures

That’s why the choice of targets matters as much as the technology used to detect them.

The choice of targets matters

Designing A Clinically Driven GI Panel

The Xpert GI Panel was designed for clinical actionability and epidemiologic relevance, aligned with U.S. and European guidelines for community-acquired AGI testing.5, 8-11

The panel includes 11 bacterial, protozoan, and viral targets that are:

  • Established causes of AGI in community settings1,3,4
  • Bacteria that can cause severe or invasive disease3
  • Associated with meaningful treatment or infection control decisions3-5
  • Relevant to antimicrobial stewardship and public health3-5,11
  • Prevalent parasites identified in AGI and amenable to targeted therapy3,5,6
  • High-burden virus (Norovirus) across age groups with propensity for institutional outbreaks12

Included targets:

Pathogen targets included in the Xpert GI Panel

Each of these pathogens has a clear downstream impact, whether that’s antimicrobial selection, cohorting and environmental decontamination, or public health notification.

 

Why Norovirus Was Prioritized in the Xpert GI Panel

Norovirus was selected as the primary viral target because of its high burden across age groups,12 role in institutional and community outbreaks,12 and implications for isolation, cohorting, and environmental cleaning.13

Target selection also required defining who the panel is—and is not—intended for.

 

Hospital‑Onset Diarrhea and C. difficile: A Different Testing Strategy

The Xpert GI Panel is designed for primary care and outpatient populations, including patients presenting to emergency departments.

Testing hospitalized patients admitted for more than three days was not part of the target selection rationale, as evidence shows that healthcare-associated diarrhea in this setting is most commonly driven by Clostridioides difficile.14

Importantly:

  • C. difficile requires a distinct diagnostic algorithm 15
  • It should be evaluated based on specific risk factors and local guidelines3,14,15
  • Studies suggest is best addressed through dedicated testing strategies, rather than routine multiplex GI panels16-18

This separation supports diagnostic stewardship and helps ensure the right test is used for the right patient.

Quote - Christophe Martinaud, MD

Why More Is Not Always Better in GI Panel Testing

Defining what not to include was as important as deciding what to target. Excluded organisms fell into several consistent categories, shown below:

Table showing examples of why pathogens were excluded

This selective approach is designed to reduce false-positive complexity and unnecessary downstream utilization, which are increasingly important considerations for laboratories and clinicians alike.

Quote - Rebekah Dumm, PhD Assistant Professor, Pathology and Immunology, WashU

What This Means for Healthcare Providers

For laboratory and clinical decision makers, the Xpert GI Panel reflects a high-value testing philosophy:

  • Focused, not bloated: Targets selected for real-world clinical relevance
  • Action-oriented: Results designed to support clinical decision‑making
  • Stewardship-aligned: Approach supports appropriate antibiotic use and infection control considerations
  • Guideline-informed: Design informed by U.S. and EU recommendations 
Urgent Care - GI Panel

Learn More About the Xpert GI Panel

Explore product resources or contact your Cepheid representative to discuss how the Xpert GI Panel fits into your GI testing strategy.

View on-demand webinars:

View Webinar

 

Optimizing Use of GI Panels – Practical Stewardship Strategies presented by Dr. Rebekah Dumm, Assistant Professor, Pathology and Immunology at Washington Univ. School of Medicine

View Webinar

 

From Detection to Decision: Stewarding Multiplex GI Panel and Targeted Testing Results in Clinical Practice presented by Dr. Nicholas M Moore, Assoc. Prof. and Assoc. Dir. of Clinical Microbiology at Rush University Medical Center link

 

 

 

 A look inside Xpert GI Panel

The views and opinions expressed by external experts are their own. Statements are based on individual clinical experience and should be interpreted in the context of the broader scientific literature.

 

IVD. In Vitro Diagnostic Medical Device. Not available in all countries.

 

References:

1. Schmidt MA et al. 2022 Incidence, Etiology, and Healthcare Utilization for Acute Gastroenteritis in the Community, United States. Emerging Infectious Diseases. 2022;28(11):2234-2242. doi:10.3201/eid2811.220247.

2. Suchman K et al. 2023 Emergency department utilization for gastrointestinal care and patient characteristics associated with hospital admission in a national cohort, Gastroenterology Report, Volume 11, 2023, goad045, https://doi.org/10.1093/gastro/goad045

3. Shane AL et al. 2017 Infectious Diseases Society of America clinical practice guidelines for the diagnosis and management of infectious diarrhea. Clin Infect Dis. 2017;65(12):e45–e80. doi:10.1093/cid/cix669

4. Shane AL et al. 2025 State-of-the-Art Review: Infectious Diarrhea, Clinical Infectious Diseases, Volume 81, Issue 5, 15 November 2025, Pages e250–e262, https://doi.org/10.1093/cid/ciaf356

5. Riddle MS et al. 2016 ACG Clinical Guideline: Diagnosis, Treatment, and Prevention of Acute Diarrheal Infections in Adults. Am J Gastroenterol 2016.

6. Moon RC et al. 2023 Epidemiology and Economic Burden of Acute Infectious Gastroenteritis Among Adults Treated in Outpatient Settings in US Health Systems. Am J Gastroenterol 2023.

7. Wilber E et al. 2021 Clinical Implications of Multiplex Pathogen Panels for the Diagnosis of Acute Viral Gastroenteritis. J Clin Microbiol.

8. Intérêt des techniques d’amplifications des acides nucléiques (TAAN) multiplex dans la prise en charge médicale des infections gastro-intestinales. Haute Autorité de Santé. Rapport d’évaluation 2024.

9. S2k-Leitlinie Gastrointestinale Infektionen der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS). AWMF-Registernummer:021–024 2023.

10. AMCLI ETS. Percorso Diagnostico Enteriti di Origine Infettiva. Rif. 2023-07. https://amcli.it/wp-content/uploads/2024/04/2023-07_ENTERITI-DI-ORIGINE-INFETTIVA-E-FLOWCHART.pdf Accessed April 2026

11. Campodónico VL et al. 2023 A diagnostic stewardship approach to prevent unnecessary testing of an enteric bacterial molecular panel. Microbiol Spectr. 2023;11(6):e02945‑23. doi:10.1128/spectrum.02945‑23.

12. Carlson KB et al. 2024 A narrative review of norovirus epidemiology, biology, and challenges to vaccine development. NPJ Vaccines. 2024 May 29;9(1):94. doi:10.1038/s41541‑024‑00884‑2. PMID:38811605; PMCID:PMC11137017.

13. Centers for Disease Control and Prevention. Guideline for the prevention and control of norovirus gastroenteritis outbreaks in healthcare settings. MMWR Recomm Rep. 2011;60(RR‑3):1–15. Updated Feb 15, 2017. https://www.cdc.gov/infection-control/media/pdfs/Guideline-Norovirus-H.pdf%20 Accessed April 2026

14. Eeuwijk, J et al. 2024 A Systematic Literature Review on Risk Factors for and Timing of Clostridioides difficile Infection in the United States. Infect Dis Ther 13, 273–298 (2024). https://doi.org/10.1007/s40121-024-00919-0

15. McDonald LC et al. 2018 Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA), Clinical Infectious Diseases, Volume 66, Issue 7, 1 April 2018, Pages e1–e48, https://doi.org/10.1093/cid/cix1085

16. Hitchcock MH et al. 2018 Low Yield of FilmArray GI Panel in Hospitalized Patients with Diarrhea: an Opportunity for Diagnostic Stewardship Intervention. J Clin Microbiol 2018

17. Aurora V et al. 2018 Overdiagnosis of Clostridioides difficile with a Multiplex PCR Panel. Open Forum Infect Dis. 2018 Nov 26;5(Suppl 1):S195–6. doi: 10.1093/ofid/ofy210.538. PMCID: PMC6253210.

18. Pender M et al. 2023 Syndromic Panel Testing Among Patients With Infectious Diarrhea: The Challenge of Interpreting Clostridioides difficile Positivity on a Multiplex Molecular Panel, Open Forum Infectious Diseases, Volume 10, Issue 5, May 2023, ofad184, https://doi.org/10.1093/ofid/ofad184

19. Hu J, Torres AG. Enteropathogenic Escherichia coli: foe or innocent bystander? Clin Microbiol Infect. 2015 Aug;21(8):729-34. doi: 10.1016/j.cmi.2015.01.015. Epub 2015 Jan 28. PMID: 25726041; PMCID: PMC4497942.

20. Denamur, E. et al. The population genetics of pathogenic Escherichia coli. Nat Rev Microbiol 19, 37–54 (2021). https://doi.org/10.1038/s41579-020-0416-x

21. Centers for Disease Control and Prevention. DPDx—Amebiasis. Atlanta (GA): CDC; 2019. Available from: https://www.cdc.gov/dpdx/amebiasis/index.html Accessed April 2026

22. Morris JG Jr, Horneman A. 2025 Plesiomonas shigelloides infections. In: Post TW, editor. UpToDate [Internet]. Waltham (MA): UpToDate; 2025;Dec 09. https://www.uptodate.com/contents/plesiomonas-shigelloides-infections Accessed April 2026

23. Degaffe GH et al. 2024 Aeromonas and Plesiomonas. In: Kliegman RM, St Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, editors. Nelson Textbook of Pediatrics. 22nd ed. Philadelphia (PA): Elsevier; 2024.

24. Keita AM et al. 2023 Prevalence, clinical severity, and seasonality of adenovirus 40/41, astrovirus, sapovirus, and rotavirus among young children with moderate-to-severe diarrhea: results from the Vaccine Impact on Diarrhea in Africa study. Clin Infect Dis. 2023;76(Suppl 1):S123–S131. doi:10.1093/cid/ciad060.

25. Flynn TG et al. 2024 Viral gastroenteritis. Lancet. 2024;403(10429):862–876. doi:10.1016/S0140-6736(23)02037-8.

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