Background Culture-independent diagnostic testing (CIDT) provides rapid results to clinicians and is quickly displacing traditional detection methods. Increased CIDT use and sensitivity likely result in higher case detection but might also obscure infection trends. Severe illness outcomes, such as hospitalization and death, are likely less affected by changes in testing practices and can be used as indicators of the expected case incidence trend had testing methods not changed. Methods Using US Foodborne Diseases Active Surveillance Network data during 1996–2019 and mixed effects quasi-Poisson regression, we estimated the expected yearly incidence for nine enteric pathogens. Results Removing the effect of CIDT use, CIDT panel testing and culture-confirmation of CIDT testing, the modelled incidence in all but three pathogens (Salmonella, Shigella, STEC O157) was significantly lower than the observed and the upward trend in Campylobacter was reversed from an observed 2.8% yearly increase to a modelled –2.8% yearly decrease (95% credible interval: –4.0, –1.4). Conclusions Severe outcomes may be useful indicators in evaluating trends in surveillance systems that have undergone a marked change.

中文翻译：

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在向独立于文化的诊断测试过渡期间对反事实发生率进行建模

背景 独立于培养物的诊断测试 (CIDT) 为临床医生提供快速结果，并正在迅速取代传统的检测方法。CIDT 使用率和敏感性的增加可能会导致病例检出率提高，但也可能掩盖感染趋势。住院和死亡等严重疾病结果可能受检测方法变化的影响较小，并且可以用作检测方法未改变时预期病例发生趋势的指标。方法 使用 1996-2019 年美国食源性疾病主动监测网络数据和混合效应准泊松回归，我们估计了九种肠道病原体的预期年发病率。结果 除去 CIDT 使用、CIDT 小组测试和 CIDT 测试培养确认的影响，除三种病原体（沙门氏菌、志贺氏菌、STEC O157）之外的所有病原体的模型发病率均显着低于观察值，并且弯曲杆菌的上升趋势与观察到的每年增长 2.8%，模拟每年下降 –2.8%（95% 可信区间：–4.0、–1.4）。结论 严重后果可能是评估发生显着变化的监测系统趋势的有用指标。