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

Published online by Cambridge University Press:  08 November 2024

Clyde D. Ford Open the ORCID record for Clyde D. Ford [Opens in a new window] ,
Bert K. Lopansri ,
Bradley D. Hunter Open the ORCID record for Bradley D. Hunter [Opens in a new window] ,
Jacob Wilkes Open the ORCID record for Jacob Wilkes [Opens in a new window] ,
Julie Asch Open the ORCID record for Julie Asch [Opens in a new window]  and
Daanish Hoda Open the ORCID record for Daanish Hoda [Opens in a new window]
Clyde D. Ford*
Affiliation:
Intermountain Acute Leukemia Program, LDS Hospital, Salt Lake City, UT, USA
Bert K. Lopansri
Affiliation:
Department of Medicine, Division of Infectious Diseases and Clinical Epidemiology, Intermountain Health, Salt Lake City, UT, USA Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, UT, USA
Bradley D. Hunter
Affiliation:
Intermountain Acute Leukemia Program, LDS Hospital, Salt Lake City, UT, USA
Jacob Wilkes
Affiliation:
Data Analytics, Intermountain Health, Salt Lake City, UT, USA
Julie Asch
Affiliation:
Intermountain Acute Leukemia Program, LDS Hospital, Salt Lake City, UT, USA
Daanish Hoda
Affiliation:
Intermountain Acute Leukemia Program, LDS Hospital, Salt Lake City, UT, USA
*
Corresponding author: Clyde D. Ford; Email: [email protected]
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Abstract

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.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 46 , Issue 1 , January 2025 , pp. 77 - 80
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Copyright
© The Author(s), 2024. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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