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Most diarrhea cases in transplant recipients had no infectious etiology
The most frequent infectious etiologies of diarrhea identified among solid organ transplant recipients included Clostridium difficile, norovirus and cytomegalovirus, data from a retrospective analysis indicated.
“The majority of both community-onset and hospital-onset admissions had no causative etiology for the diarrhea identified,” the researchers wrote in Clinical Infectious Diseases. “Our criteria for clinical diagnoses such as antibiotic-associated, mycophenolate mofetil-, or mycophenolic acid-associated diarrheal illness likely precluded instances where these may have contributed.”
Ignacio A. Echenique, MD, of the division of infectious diseases at Northwestern University Feinberg School of Medicine, and colleagues conducted the retrospective analysis during an 18-month period. They identified solid organ transplant recipients with complaints of diarrhea. The analysis included 422 admissions (314 unique patients) with community-onset diarrhea and 112 admissions (102 unique patients) with hospital-onset diarrhea.
Among cases of community-onset diarrhea with a single diagnosis, 60.9% of cases had no specified etiology. For the remaining cases, 13% were due to C. difficile, 8.1% were due to norovirus, and 6.2% were attributed to CMV disease/colitis.
For hospital-onset cases, 75.9% of cases had no specified etiology. C. difficile was the etiology for 11.6 cases, norovirus was the cause of 2.7% of cases, and CMV disease/colitis was the cause of 2.7% of cases.
“Despite a variety of available testing modalities, the greatest yields were derived from stool norovirus PCR, C. difficile PCR, blood CMV viral load and stool culture,” the researchers wrote. “It is not yet established if testing should be performed simultaneously, sequentially, tiered or otherwise stratified. Based on our results, a reasonable up-front strategy may include the aforementioned tests.”
Disclosure: The researchers report no relevant financial disclosures.