Multi-organism gastrointestinal polymerase chain reaction positivity among pediatric transplant vs non-transplant populations: A single-center experience

Pediatr Transplant. 2020 Sep;24(6):e13771. doi: 10.1111/petr.13771. Epub 2020 Jul 8.


Background: Diarrhea is a common problem in the pediatric post-solid organ transplant and post-hematopoietic stem cell transplant populations. Infectious etiology incidences are poorly defined, and the possibility of multi-organism positivity is often uninvestigated. The aim of this study is to utilize stool multiplex GIP assays to compare the PTP and NTP regarding the incidence and profiles of single-organism and multi-organism infectious diarrhea.

Methods: A single-center retrospective review was conducted, investigating stool multiplex GIP panel results over a more than 3-year period, for pediatric patients. Assays test for 23 viral, bacterial, and protozoal organisms.

Results: Positive assays in the PTP and NTP were 70/101 (69.3%) and 962/1716 (56.1%), respectively (P = .009). Thirty-two percent (32/101) of assays within the PTP were multi-organism positive, significantly more than 14.8% (254/1716) in the NTP (P < .00001). There was no significant difference in the incidence of single-organism positives, 37.6% (38/101) in PTP and 41.3% (708/1716) in the NTP. The PTP demonstrated a statistically significantly higher incidence of the following organisms within multi-agent positive GIPs (P < .05 for each): Clostridioides difficile, Cryptosporidium, EPEC, norovirus, and sapovirus.

Conclusions: The pediatric PTP demonstrates higher incidence of positive GIPs, higher rate of multi-organism positivity, and unique infectious organism incidence profiles. These data can provide a framework for understanding organism-specific pathogenicity factors, assessing the clinical impact of enteric co-infection, and understanding the utility of this testing modality in this unique population.

Keywords: diarrhea; multi-organism; pediatric; polymerase chain reaction; transplant.

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Clostridioides difficile
  • Cryptosporidiosis
  • Cryptosporidium
  • Diarrhea / complications*
  • Diarrhea / microbiology*
  • Enteropathogenic Escherichia coli
  • Feces / microbiology
  • Feces / virology
  • Female
  • Hematopoietic Stem Cell Transplantation / adverse effects
  • Humans
  • Incidence
  • Infant
  • Infant, Newborn
  • Male
  • Norovirus
  • Organ Transplantation / adverse effects
  • Pediatrics / methods*
  • Polymerase Chain Reaction
  • Quality of Life
  • Retrospective Studies
  • Sapovirus
  • Treatment Outcome