title: Diagnostic yields in solid organ transplant recipients admitted with diarrhea.
abstract: BACKGROUND
  Although diarrhea is a frequent complaint among solid organ transplant recipients, the contribution of infectious etiologies remains incompletely defined. We sought to define the etiologies of diarrhea and the yields of testing at our institution.
  
  
  METHODS
  We performed a retrospective analysis over an 18-month period of hospitalized solid organ transplant recipients. We stratified diarrhea by community onset vs hospital onset of diarrhea.
  
  
  RESULTS
  We identified 422 admissions (representing 314 unique patients) with community-onset diarrhea, and 112 admissions (representing 102 unique patients) with hospital-onset diarrhea. The majority of community- and hospital-onset diarrheal episodes had no identified etiology (60.9% and 75.9%, respectively; P = .03), yet were also self-limited (91% and 91%, respectively; P = .894). Thereafter, the most frequently encountered infectious etiologies were Clostridium difficile infection (13.3% and 11.8%, respectively), norovirus enteritis (8.2% and 3%), cytomegalovirus disease or colitis (6.3% and 2.7%), and bacterial enterocolitis (0.9% and 0%) (P = .03). In aggregate, these entities represented 93.7% and 90.5% of the identified infectious etiologies, respectively. Protozoan causes were rarely seen. Coinfection, or the simultaneous detection of ≥2 pathogens, occurred in 8 (1.9%) and 2 (1.8%) community- and hospital-onset diarrheal admissions, respectively (P = .99).
  
  
  CONCLUSIONS
  In solid organ transplant recipients who presented at our institution with diarrhea, approximately one-third had infectious etiologies identified, consisting predominantly of C. difficile, norovirus, cytomegalovirus, and bacterial enterocolitis. Other infectious etiologies were rare.
authors.affiliation: Division of Infectious Diseases.
authors.forename: Ignacio A
authors.initials: IA
authors.lastname: Echenique
authors.affiliation: Division of Infectious Diseases.
authors.forename: Sudhir
authors.initials: S
authors.lastname: Penugonda
authors.affiliation: Division of Infectious Diseases Division of Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Valentina
authors.initials: V
authors.lastname: Stosor
authors.affiliation: Division of Infectious Diseases Division of Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Ison
authors.affiliation: Division of Infectious Diseases.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Angarone
mesh_terms: D000368:Aged; D001419:Bacteria / Q000302:isolation & purification; D003141:Communicable Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology*; D003967:Diarrhea / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D066027:Transplant Recipients; D019737:Transplants; D014780:Viruses / Q000302:isolation & purification
keywords: Clostridium difficile; cytomegalovirus; diarrhea; norovirus; solid organ transplant