Culture-independent diagnostic techniques (CIDT) are increasingly used to detect gastrointestinal pathogens as they offer short turnaround times, high sensitivities and specificities, and ultimately improve patient care. However, the absence of clinical isolates may hamper epidemiological investigations and public health surveillance. In Belgium, CIDT for gastrointestinal pathogens are not widely used yet, but a change in the reimbursement conditions might affect laboratory practices.

In the context of the project United 4 Surveillance, whose main objective is to strengthen surveillance of infectious diseases in Europe, we carried out an online survey in April 2024 among medical laboratories in Belgium. The aim was to (i) estimate current diagnostic practices, (ii) assess future diagnostic practices in light of the upcoming change in test reimbursement and (iii) estimate the interest of laboratories for public health questions for Salmonella, Shigella, Yersinia, STEC and Campylobacter.

The participation rate was 80% (90/113). For STEC, up to 55% of the laboratories are currently using CIDT with an increase to 85% when CIDT will be added to the reimbursement conditions. For the other four pathogens, 75 to 95% of the laboratories currently perform culture, but a change in diagnostic practice towards CIDT is foreseen (55-70%) when included in the reimbursement scheme. More than 80% of the laboratories intend to perform reflex cultures or send samples to the national reference centers.

A switch in diagnostic practices towards CIDT for gastrointestinal pathogens is expected but there is a strong intention of the laboratories to participate to surveillance activities. The impact of this change will be monitored closely to maintain a comprehensive view on circulating strains for public health surveillance.