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- Title
Diagnostic Yields in Solid Organ Transplant Recipients Admitted With Diarrhea.
- Authors
Echenique, Ignacio A.; Penugonda, Sudhir; Stosor, Valentina; Ison, Michael G.; Angarone, Michael P.
- Abstract
Solid organ transplant recipients frequently suffer diarrhea. In 534 admissions over an 18-month study period 30.1% of community-onset diarrhea was found to be infectious, consisting predominantly of Clostridium difficile, norovirus, and cytomegalovirus, whereas other causes were rare.Background. Although diarrhea is a frequent complaint among solid organ transplant recipients, the contribution of infectious etiologies remains incompletely defined. We sought to define the etiologies of diarrhea and the yields of testing at our institution.Methods. We performed a retrospective analysis over an 18-month period of hospitalized solid organ transplant recipients. We stratified diarrhea by community onset vs hospital onset of diarrhea.Results. We identified 422 admissions (representing 314 unique patients) with community-onset diarrhea, and 112 admissions (representing 102 unique patients) with hospital-onset diarrhea. The majority of community- and hospital-onset diarrheal episodes had no identified etiology (60.9% and 75.9%, respectively; P = .03), yet were also self-limited (91% and 91%, respectively; P = .894). Thereafter, the most frequently encountered infectious etiologies were Clostridium difficile infection (13.3% and 11.8%, respectively), norovirus enteritis (8.2% and 3%), cytomegalovirus disease or colitis (6.3% and 2.7%), and bacterial enterocolitis (0.9% and 0%) (P = .03). In aggregate, these entities represented 93.7% and 90.5% of the identified infectious etiologies, respectively. Protozoan causes were rarely seen. Coinfection, or the simultaneous detection of ≥2 pathogens, occurred in 8 (1.9%) and 2 (1.8%) community- and hospital-onset diarrheal admissions, respectively (P = .99).Conclusions. In solid organ transplant recipients who presented at our institution with diarrhea, approximately one-third had infectious etiologies identified, consisting predominantly of C. difficile, norovirus, cytomegalovirus, and bacterial enterocolitis. Other infectious etiologies were rare.
- Subjects
DIARRHEA; THERAPEUTICS; COMPLICATIONS from organ transplantation; CYTOMEGALOVIRUS disease diagnosis; ETIOLOGY of diseases; MYCOPHENOLIC acid
- Publication
Clinical Infectious Diseases, 2015, Vol 60, Issue 5, p729
- ISSN
1058-4838
- Publication type
Article
- DOI
10.1093/cid/ciu880