NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA.
Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA.
Clin Infect Dis. 2020 Oct 23;71(7):1693-1700. doi: 10.1093/cid/ciz1068.
Diarrhea is common and associated with substantial morbidity among hematopoietic cell transplant (HCT) recipients, but the etiology is often not identified. Multiplexed polymerase chain reaction (PCR) assays increase the detection of diarrheal pathogens, but the impact of this technology in this population has not been evaluated.
Our center replaced stool cultures and other conventional microbiologic methods with the FilmArray Gastrointestinal Panel (GI PCR) in June 2016. We reviewed all adult patients who received an HCT from June 2014-May 2015 (pre-GI PCR, n = 163) and from June 2016-May 2017 (post-GI PCR, n = 182) and followed them for 1 year after transplantation. Clostridioides difficile infection was diagnosed by an independent PCR test in both cohorts.
The proportion of patients with ≥1 identified infectious diarrheal pathogen increased from 25% to 37% after implementation of GI PCR (P = .01). Eight patients (5%) in the pre-GI PCR cohort tested positive for a pathogen other than C. difficile versus 49 patients (27%) in the post-GI PCR cohort (P < .001). The most common non-C. difficile diarrheal pathogens in the post-GI PCR cohort were enteropathogenic Escherichia coli (n = 14, 8%), norovirus (n = 14, 8%), and Yersinia enterocolitica (n = 7, 4%). The percentage of diarrheal episodes with an identified infectious etiology increased from 14% to 23% (P = .001). Median total costs of stool testing per patient did not increase (pre: $473; post: $425; P = .25).
Infectious etiologies of diarrhea were identified in a higher proportion of HCT recipients after replacing conventional stool testing with a multiplexed PCR assay, without an increase in testing costs.
腹泻在造血细胞移植（HCT）受者中很常见，且与大量发病率相关，但病因通常无法确定。多重聚合酶链反应（PCR）检测可提高腹泻病原体的检出率，但该技术在该人群中的影响尚未得到评估。
我们中心于 2016 年 6 月用 FilmArray 胃肠道Panel（GI-PCR）替代了粪便培养和其他传统微生物学方法。我们回顾了 2014 年 6 月至 2015 年 5 月（GI-PCR 前，n = 163）和 2016 年 6 月至 2017 年 5 月（GI-PCR 后，n = 182）期间接受 HCT 的所有成年患者，并在移植后随访 1 年。在两个队列中均通过独立的 PCR 检测诊断艰难梭菌感染。
在实施 GI-PCR 后，≥1 种确定的传染性腹泻病原体的患者比例从 25%增加到 37%（P =.01）。在 GI-PCR 前队列中，有 8 名（5%）患者除艰难梭菌外，还有其他病原体检测阳性，而在 GI-PCR 后队列中有 49 名（27%）患者（P <.001）。在 GI-PCR 后队列中，最常见的非艰难梭菌腹泻病原体是肠致病性大肠杆菌（n = 14，8%）、诺如病毒（n = 14，8%）和小肠结肠炎耶尔森菌（n = 7，4%）。有明确传染性病因的腹泻发作比例从 14%增加到 23%（P =.001）。每位患者的粪便检测总成本并未增加（前：$473；后：$425；P =.25）。
用多重 PCR 检测替代传统粪便检测后，HCT 受者腹泻的感染性病因比例更高，且检测成本没有增加。
