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Fecal Microbiota Transplantation via Colonoscopy for Recurrent C. difficile Infection
Published on: December 8, 2014
PCR-based versus conventional stool tests in children with diarrhea who underwent solid organ transplantation or
Seewalee Sidafong1, Pornthep Tanpowpong, Sophida Boonsathorn
1Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Insights
Polymerase chain reaction (PCR)-based stool tests detect more infectious diarrhea causes in children post-transplant than conventional methods. These advanced tests aid in guiding appropriate antimicrobial therapy for better patient management.
Area of Science:
- Pediatric Infectious Diseases
- Transplant Medicine
- Clinical Microbiology
Background:
- Infectious diarrhea is a frequent complication in pediatric transplant recipients.
- Conventional stool tests have limitations in diagnosing the causative agents of infectious diarrhea.
- Data on the utility of advanced diagnostic methods like polymerase chain reaction (PCR) in this population are scarce.
Purpose of the Study:
- To evaluate the diagnostic yield of PCR-based stool tests in children following transplantation.
- To compare the detection rates of PCR versus conventional stool tests.
- To assess the impact of PCR-based stool test results on the management of diarrhea in pediatric transplant recipients.
Main Methods:
- A retrospective analysis of 68 pediatric patients (aged 1-19 years) who underwent solid organ or hematopoietic stem cell transplantation.
- Inclusion criteria: immunosuppression and diarrhea lasting ≥ 24 hours between January 2015 and February 2023.
- Collection of data on demographics, clinical characteristics, and management, alongside stool test results (PCR and conventional).
Main Results:
- PCR-based tests identified pathogens in 41.8% of diarrheal episodes, significantly higher than conventional tests (16.5%).
- PCR showed superior detection of Salmonella spp. and viruses (especially norovirus), while conventional tests were better for Clostridioides difficile.
- PCR results influenced management decisions in 58% of cases, particularly for Campylobacter jejuni and C. difficile infections.
Conclusions:
- PCR-based stool tests offer a higher diagnostic yield compared to conventional methods for infectious diarrhea in pediatric transplant recipients.
- These advanced tests can guide clinicians in selecting appropriate antimicrobial agents, potentially improving patient outcomes.
- Further research may elucidate the cost-effectiveness and broader clinical impact of PCR stool testing in this vulnerable patient group.
Abstract:
Infectious diarrhea is a common problem among post-transplant recipients. Compared to conventional tests, polymerase chain reaction (PCR)-based stool tests have been shown to improve diagnostic yield but the aforementioned data in children remain limited. Our aims were to assess the detection rate of PCR-based tests in post-transplant children and compare with the conventional tests; and to investigate how these stool tests help in managing these children. We enrolled children aged 1 to 19 years who underwent solid organ transplantation or hematopoietic stem cell transplantation that remained on immunosuppressive agents and developed diarrhea ≥ 24 hours between January 2015 and February 2023. Besides stool tests, data on demographics, clinical characteristics and management were collected. We analyzed 68 patients and 92 episodes of diarrhea with PCR-based tests. PCR-based tests provided a detection rate of 41.8% versus 16.5% for the conventional tests. While conventional tests may detect a higher proportion of Clostridiodes difficile infection, PCR-based tests showed greater yields in detecting Salmonella spp. and viruses especially norovirus. PCR-based tests had an impact in management among 22/38 (58%) diarrheal episodes especially with Campylobacter jejuni and C difficile; and among 16 episodes that positive PCR-based tests had a minimal impact, the most common reason was due to the need for continuation of antimicrobial agents for concomitant site-specific infection (69%). Among transplanted children presenting with diarrhea, PCR-based tests provide a higher yield when compared with the conventional tests. The PCR-based stool tests may also further guide clinicians for providing proper antimicrobial agents.
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