The role of gastrointestinal pathogen polymerase chain reaction testing in liver transplant recipients hospitalized withdiarrhea.

Abstract

Diarrhea is a common symptom among liver transplant (LT) recipients and can result in significant morbidity. The utility of PCR-based multiplex gastrointestinal (GI) pathogen panels in this population is unknown. We assessed incidence, predictors, and outcomes of GI PCR positivity among inpatients who underwent stool pathogen testing with the FilmArray multiplex GI PCR panel at our institution within 1 year following LT from April 2015 to December 2019. A total of 112 patients were identified. Of these, 14 (12.5%) had a positive PCR for any pathogen. Escherichia coli (n=9) and Norovirus (n=5) were the most common pathogens detected. Recipients with a positive PCR were significantly further from LT (median 74.5vs. 15.5 days, p<.01) and tested earlier during hospitalization (median 1.0vs. 9.0 days, p<.01). C. difficile was positive in 20.0% of patients with a positive PCR and 11.4% with a negative PCR. CMV viremia was observed in 11.6% of patients, all in the negative PCR group. Following a positive PCR, patients were more likely to have a change in antimicrobial regimen (71.4%vs. 28.6%, p=.02), a shorter length of stay (median 7.5vs. 17.5 days, p<.01), and a trend toward lower rates of readmission and colonoscopy within 30days. In hospitalized LT recipients with diarrhea, GI PCR pathogen identification was associated with the use of targeted antimicrobial therapy and a shorter length of stay. GI PCR testing should be considered early during admission and later in the post-LT period.