Diagnostic yields in solid organ transplant recipients admitted with diarrhea

Ignacio A. Echenique, Sudhir Penugonda, Valentina Stosor, Michael G. Ison, Michael P. Angarone*

*Corresponding author for this work

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)729-737
Number of pages9
JournalClinical Infectious Diseases
Volume60
Issue number5
DOIs
StatePublished - Jan 1 2015

Fingerprint

Diarrhea
Transplants
Enterocolitis
Norovirus
Clostridium difficile
Community Hospital
Cytomegalovirus
Clostridium Infections
Enteritis
Colitis
Transplant Recipients
Coinfection

Keywords

  • Clostridium difficile
  • Cytomegalovirus
  • Diarrhea
  • Norovirus
  • Solid organ transplant

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

@article{c03df367a96e4055970f87c76890bbd5,
title = "Diagnostic yields in solid organ transplant recipients admitted with diarrhea",
abstract = "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.",
keywords = "Clostridium difficile, Cytomegalovirus, Diarrhea, Norovirus, Solid organ transplant",
author = "Echenique, {Ignacio A.} and Sudhir Penugonda and Valentina Stosor and Ison, {Michael G.} and Angarone, {Michael P.}",
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Diagnostic yields in solid organ transplant recipients admitted with diarrhea. / Echenique, Ignacio A.; Penugonda, Sudhir; Stosor, Valentina; Ison, Michael G.; Angarone, Michael P.

In: Clinical Infectious Diseases, Vol. 60, No. 5, 01.01.2015, p. 729-737.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Diagnostic yields in solid organ transplant recipients admitted with diarrhea

AU - Echenique, Ignacio A.

AU - Penugonda, Sudhir

AU - Stosor, Valentina

AU - Ison, Michael G.

AU - Angarone, Michael P.

PY - 2015/1/1

Y1 - 2015/1/1

N2 - 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.

AB - 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.

KW - Clostridium difficile

KW - Cytomegalovirus

KW - Diarrhea

KW - Norovirus

KW - Solid organ transplant

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