Diagnostic performance of a multiplexed gastrointestinal PCR panel for identifying diarrheal pathogens in children undergoing hematopoietic stem cell transplant  

作　　者：Yue Tao Cheng-Juan Luo Bing-Hua Zhang Xin-Yan Shen Rui-Ke Zhao Bei-Ying Ma Nan Shen Chang-Ying Luo Jian-Min Wang Yi-Jun Xia Li Xie Jing Chen Xi Mo 

机构地区：[1]Pediatric Translational Medicine Institute,Shanghai Children’s Medical Center,School of Medicine,Shanghai Jiao Tong University,1678 Dongfang Rd.,Shanghai,200127,China [2]Department of Hematology and Oncology,Shanghai Children’s Medical Center,School of Medicine,Shanghai Jiao Tong University,1678 Dongfang Rd.,Shanghai,200127,China [3]Department of Infectious Diseases,Shanghai Children’s Medical Center,School of Medicine,Shanghai Jiao Tong University,Shanghai,China [4]Medical Affairs,BioMérieux(Shanghai)Company,Limited,Shanghai,China [5]Clinical Research Institute,School of Medicine,Shanghai Jiao Tong University,Shanghai,China

出　　处：《World Journal of Pediatrics》2024年第9期966-975,共10页世界儿科杂志（英文版）

基　　金：approved by the Institutional Review Board and the Ethics Committee of Shanghai Children’s Medical Center(SCMCIRB-K2018109);written informed consent was obtained from each patient and/or their parents.

摘　　要：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 mo

关 键 词：CHILDREN DIARRHEA Hematopoietic stem cell transplantation Multiplexed polymerase chain reaction 

分 类 号：R329.2[医药卫生—人体解剖和组织胚胎学]