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Diagnostic performance of a multiplexed gastrointestinal PCR panel for identifying diarrheal pathogens in children
Yue Tao1, Cheng-Juan Luo2, Bing-Hua Zhang2
1Pediatric Translational Medicine Institute, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, 1678 Dongfang Rd., Shanghai, 200127, China. taoyue@scmc.com.cn.
Insights
Hematopoietic stem cell transplantation (HSCT) patients frequently experience diarrhea due to infections. Pre-transplant gut pathogen colonization significantly increases the risk of post-transplant infectious diarrhea, highlighting the need for improved diagnostics.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Hematology
Background:
- Diarrhea is a common and serious complication following hematopoietic stem cell transplantation (HSCT).
- The causes of diarrhea in HSCT patients are diverse, including infections, medication side effects, and graft-versus-host disease (GVHD), often presenting multifactorially.
- Accurate diagnosis of diarrhea etiology in HSCT recipients is challenging due to overlapping symptoms and causes.
Purpose of the Study:
- To assess the diagnostic utility of the FilmArray gastrointestinal (GI) panel in identifying causes of diarrhea in HSCT patients.
- To determine the predictive value of pre-transplantation gastrointestinal pathogen colonization for post-transplantation infectious diarrhea.
Main Methods:
- A prospective study involving 158 patients undergoing HSCT.
- Stool samples were collected pre-transplantation, post-transplantation (day 28±7), and during new diarrhea episodes.
- Samples were analyzed using the FilmArray GI panel and other standard microbiological assays.
Main Results:
- Infections were the primary cause of post-transplant diarrhea (67.86%), followed by medication (45.24%) and GVHD (25.00%).
- Patients with pre-transplant colonization (49.47%) had a significantly higher incidence of infectious diarrhea compared to non-colonized patients (15.87%).
- The FilmArray GI panel nearly doubled the diagnostic yield for diarrheal pathogens (59.78% vs. 32.61%).
Conclusions:
- Over half of pediatric HSCT patients were colonized with GI pathogens, with over a third linked to post-transplant diarrhea.
- The FilmArray GI panel enhances pathogen detection in this population, though optimization for specific pathogens is needed.
- Further research is required to evaluate the clinical impact and cost-effectiveness of the FilmArray GI panel in pediatric HSCT patients.
Background:
Diarrhea is a common complication of hematopoietic stem cell transplantation (HSCT) and is associated with substantial morbidity, but its etiology is often unknown. Etiologies of diarrhea in this population include infectious causes, chemotherapy- or medication-induced mucosal injury and graft-versus-host disease (GVHD). Distinguishing these potential causes of diarrhea is challenging since diarrheal symptoms are often multifactorial, and the etiologies often overlap in transplant patients. The objectives of this study were to evaluate whether the FilmArray gastrointestinal (GI) panel would increase diagnostic yield and the degree to which pre-transplantation colonization predicts post-transplantation infection.
Methods:
From November 2019 to February 2021, a total of 158 patients undergoing HSCT were prospectively included in the study. Stool specimens were obtained from all HSCT recipients prior to conditioning therapy, 28 ± 7 days after transplantation and at any new episode of diarrhea. All stool samples were tested by the FilmArray GI panel and other clinical microbiological assays.
Results:
The primary cause of post-transplantation diarrhea was infection (57/84, 67.86%), followed by medication (38/84, 45.24%) and GVHD (21/84, 25.00%). Ninety-five of 158 patients were colonized with at least one gastrointestinal pathogen before conditioning therapy, and the incidence of infectious diarrhea was significantly higher in colonized patients (47/95, 49.47%) than in non-colonized patients (10/63, 15.87%) (P < 0.001). Fourteen of 19 (73.68%) patients who were initially colonized with norovirus pre-transplantation developed a post-transplantation norovirus infection. Twenty-four of 62 (38.71%) patients colonized with Clostridium difficile developed a diarrheal infection. In addition, FilmArray GI panel testing improved the diagnostic yield by almost twofold in our study (55/92, 59.78% vs. 30/92, 32.61%).
Conclusions:
Our data show that more than half of pediatric patients who were admitted for HSCT were colonized with various gastrointestinal pathogens, and more than one-third of these pathogens were associated with post-transplantation diarrhea. In addition, the FilmArray GI panel can increase the detection rate of diarrheal pathogens in pediatric HSCT patients, but the panel needs to be optimized for pathogen species, and further studies assessing its clinical impact and cost-effectiveness in this specific patient population are also needed.
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