| Abstract: |
Multiple microbiologic tests are frequently ordered to evaluate diarrhea after HSCT. However, little is known about the utility of this approach. We therefore determined incidence, organisms and timing of infectious causes of diarrhea in adult and pediatric HSCT pts. We also reviewed diagnostic utility of tests and suggest an efficient evaluation of diarrhea. Methods: Retrospective review of database of 167pts who received allo HSCT from 1/1/00 to 12/31/01 for any one of the following tests submitted for work up of diarrhea from day -10 to 90 after HSCT: Stool viral cultures (VC), ELISA for rotavirus (RV), bacterial cultures (BC), Clostridium difficile toxin (Cdiff), and ova/parasites (OP). Examined timeframes included early (-10 to 30) and late (31 to 90) days (d) from HSCT. Episodes, not isolates, were determined and tabulated. Results: During 2 yrs, 102 adults (median age 41 y) and 56 children (10 y) had >1 stool study. Transplant type included Unrelated: 38%, T-cell depleted: 64%. Median duration of neutropenia was 16 d. Infectious episodes: Adenovirus 12 (9pts, 3 with both early and late). C. diff: 34 (29pts, 4 recurrent). Conclusions: 1) The most common infection was C. diff, with incidence 17% (29/167pts) followed by adenovirus (6%). 2) Children had higher incidence than adults for C. diff (18 vs 7%) and adenovirus (7 vs 3%). 2) BC, OP and RV comprised 50% of all tests, (0.5% positive yield) and one treatable Giardia infection. 3) We suggest evaluation focus on C. diff and adenovirus. 4) Screening for BC, OP and RV should be done only once because repeat specimens do not increase diagnostic yield. |
