Multiplexed Gastrointestinal PCR Panels for the Evaluation of Diarrhea in Hematopoietic Stem Cell Transplantation Recipients

Ford, Clyde D.; Lopansri, Bert K.; Hunter, Bradley D.; Asch, Julie; Hoda, Daanish

doi:10.1016/j.jtct.2024.05.013

Transplantation and Cellular Therapy

2024

DOI: 10.1016/j.jtct.2024.05.013

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Multiplexed Gastrointestinal PCR Panels for the Evaluation of Diarrhea in Hematopoietic Stem Cell Transplantation Recipients

Clyde D. Ford,

Bert K. Lopansri,

Bradley D. Hunter

et al.

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2024

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Cited by 2 publications

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Multiplexed gastrointestinal PCR panels for the evaluation of diarrhea in patients with acute leukemia

Ford,

Lopansri,

Hunter

et al. 2024

Infect. Control Hosp. Epidemiol.

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Objective: To better delineate multiplexed gastrointestinal polymerase chain reaction (PCR) panel (MGPP) diagnostic and therapeutic stewardship for patients undergoing treatment for acute leukemia including indications and benefits of testing, optimal timing, and interpretation of results. Study design: We retrieved all MGPP ordered on 662 consecutive patients admitted with newly diagnosed acute leukemia between June 2015 and May 2024. Setting: Regional referral center for acute leukemia. Results: Fifty-one (17%) of 305 MGPP obtained on the 198 patients who underwent testing identified at least one and 4 (1%) more than one diarrheagenic pathogen. The probability of a positive result was greater if obtained as an outpatient [20/52(38%)], but was not related to type of leukemia, sex, or age. Among the positive results, the pathogens identified included Clostridioides difficile (78% of tests), norovirus (16%), diarrheagenic Escherichia coli (6%), adenovirus 40/41 (4%), and Giardia lamblia (4%). The results of 30 of the 305 tests resulted in a change in treatment (28 C. difficile, 2 G. lamblia). For the MGPP C. difficile results with an accompanying toxin determination, this included treatment following 16/19 tests with a positive toxin result and 11/19 with a negative. Actionable results other than C. difficile were rarely seen in the inpatient population. Conclusions: MGPP testing is most useful when administered as an outpatient and of little benefit for inpatients with hospital-onset diarrhea. Since MGPP is sensitive and does not distinguish between colonization and causes of diarrhea, caution is needed in interpretation of results, especially for toxin-negative C. difficile.

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Multiplexed gastrointestinal PCR panels for the evaluation of diarrhea in patients with acute leukemia

Ford,

Lopansri,

Hunter

et al. 2024

Infect. Control Hosp. Epidemiol.

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Diagnosis of Clostridioides difficile infection and impact of testing

Viprey,

Clark,

Davies

2024

Journal of Medical Microbiology

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Diagnosis of Clostridioides difficile infection (CDI) remains challenging as it involves in the first instance recognition (clinical awareness) of the patients’ symptoms for clinical suspicion of CDI to warrant testing, and secondly, different laboratory tests have been described for CDI. Due to the overwhelming amount of information in the literature on CDI tests and their performance, with separately published guidelines, this review aims to provide a comprehensive but concise summary of the current state of CDI diagnostic testing. Current knowledge and the impact of using different laboratory diagnostic procedures for CDI, including the most recommended approach as a two-step algorithm and the concept of diagnostic stewardship, are being discussed. This review provides an updated overview and valuable take-home messages in the field of CDI laboratory testing and highlights that timely diagnosis is important for the clinical management of CDI and that the recommended testing procedures are increasingly becoming more widely accepted.

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Multiplexed Gastrointestinal PCR Panels for the Evaluation of Diarrhea in Hematopoietic Stem Cell Transplantation Recipients

Cited by 2 publications

References 25 publications

Multiplexed gastrointestinal PCR panels for the evaluation of diarrhea in patients with acute leukemia

Multiplexed gastrointestinal PCR panels for the evaluation of diarrhea in patients with acute leukemia

Diagnosis of Clostridioides difficile infection and impact of testing

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