Atamna Alaa, Rahamimov Ruth, Levit Aviel, Saleh Loulou, Zvi Haim Ben, Bishara Jihad, Yahav Dafna
Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.
Tel Aviv Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
Infect Dis Ther. 2024 Nov;13(11):2415-2422. doi: 10.1007/s40121-024-01056-4. Epub 2024 Oct 14.
Diarrhea is a frequent complication after kidney transplantation, however the etiology is often not identified. Multiplex PCR assays may increase the detection of diarrheal pathogens among kidney transplant recipients (KTRs), leading to improved management.
This was a retrospective before-after study, conducted in a high-volume transplant center. In September 2017, multiplex PCR assay was introduced. We reviewed all hospitalized KTRs with diarrhea during 1/2015-8/2017 (pre-GI PCR, n = 111) and 9/2017-12/2021 (GI PCR, n = 159) and followed them for 3 years. We performed univariate and multivariate analysis for predictors of pathogen identification, introducing the study period as an independent variable.
Among 270 hospitalized KTRs with diarrhea, 64 (24%) had an identified diarrheal pathogen. The proportion of KTRs with an identified pathogen increased from 20% (13/64) in the pre-GI PCR to 80% (51/64) post GI PCR (p < 0.01). Of 51 KTRs with an identified pathogen in the post GI PCR, 44 (86%) were diagnosed using GI PCR. GI PCR was more likely used in younger KTRs with more recent transplantation and higher creatinine level at admission. The most common non-C. difficile diarrheal pathogens in the post-GI PCR cohort were enteropathogenic Escherichia coli (n = 23, 58%), norovirus (n = 11, 28%), and Campylobacter (n = 11, 28%). Implementing GI PCR significantly increased the detection and identification of GI pathogens (odds ratio [OR] = 21, CI 95% 10-44; p < 0.001).
Infectious etiologies of diarrhea were identified in a higher proportion of KTRs after the implementation of GI PCR. This emphasizes the importance of integrating this diagnostic tool into diarrhea workup in KTRs.
腹泻是肾移植术后常见的并发症，但其病因往往难以明确。多重聚合酶链反应（PCR）检测可能会提高肾移植受者（KTRs）腹泻病原体的检出率，从而改善治疗效果。
这是一项在大型移植中心进行的前后对照回顾性研究。2017年9月引入了多重PCR检测。我们回顾了2015年1月至2017年8月（胃肠道PCR检测前，n = 111）以及2017年9月至2021年12月（胃肠道PCR检测，n = 159）期间所有因腹泻住院的KTRs，并对他们进行了3年的随访。我们将研究时间段作为自变量，对病原体鉴定的预测因素进行了单因素和多因素分析。
在270例因腹泻住院的KTRs中，64例（24%）检出了腹泻病原体。检出病原体的KTRs比例从胃肠道PCR检测前的20%（13/64）增至胃肠道PCR检测后的80%（51/64）（p < 0.01）。在胃肠道PCR检测后检出病原体的51例KTRs中，44例（86%）通过胃肠道PCR检测得以确诊。胃肠道PCR检测更常用于移植时间更近、入院时肌酐水平更高的年轻KTRs。胃肠道PCR检测后队列中最常见的非艰难梭菌腹泻病原体为肠致病性大肠杆菌（n = 23，58%）、诺如病毒（n = 11，28%）和弯曲杆菌（n = 11，28%）。实施胃肠道PCR检测显著提高了胃肠道病原体的检出和鉴定率（优势比[OR] = 21，95%置信区间10 - 44；p < 0.001）。
实施胃肠道PCR检测后，更高比例的KTRs腹泻的感染病因得以明确。这凸显了将这一诊断工具纳入KTRs腹泻检查的重要性。
