Risk factors and clinical outcomes associated with multiple as opposed to single pathogens detected on the gastrointestinal disease polymerase chain reaction assay.

IF 4.3 3区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Gut Pathogens Pub Date : 2024-08-30 DOI:10.1186/s13099-024-00638-4

Insa Mannstadt, Alexa M Choy, Jianhua Li, Daniel A Green, Daniel E Freedberg

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Abstract

Background: The use of gastrointestinal disease multiplex polymerase chain reaction (GI PCR) testing has become common for suspected gastrointestinal infection. Patients often test positive for multiple pathogens simultaneously through GI PCR, although the clinical significance of this is uncertain.

Methods: This retrospective cohort study investigated risk factors and clinical outcomes associated with detection of multiple (as opposed to single) pathogens on GI PCR. We included adult patients who underwent GI PCR testing from 2020 to 2023 and had one or more pathogens detected. We compared patients with multiple versus those with single pathogens and hypothesized that immunosuppression would be a risk factor for detection of multiple pathogens. We further hypothesized that, during the 90 days after GI PCR testing, patients with multiple pathogens would have worse clinical outcomes such as increased rates of emergency department (ED) visits, death, hospitalization, or ambulatory care visits.

Results: GI PCR was positive in 1341 (29%) of tested patients; 356 patients had multiple pathogens and 985 had one pathogen. The most common pathogens included Enteropathogenic Escherichia coli (EPEC, 27%), norovirus (17%), and Enteroaggregative E. coli (EAEC, 14%) in both multi- and singly positive patients. Immunosuppression was not associated with multiple pathogens (adjusted odds ratio [aOR] 1.35, 95% CI 0.96, 1.86). The factors most associated with multiple pathogens were Hispanic ethnicity (OR 1.86, 95% CI 1.42, 2.45) and chronic kidney disease (OR 1.69, 95% CI 1.13, 2.49). Patients with multiple pathogens were more likely to have ED visits during the 90 days after GI PCR testing (40% vs. 32%, p < 0.01), but they were not more likely to die, be hospitalized, or to have ambulatory medical visits.

Conclusions: Immunosuppression was not associated with detection of multiple as opposed to single pathogens on GI PCR testing. There were worse clinical outcomes associated with detection of multiple pathogens, although these effects were modest.

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与胃肠道疾病聚合酶链反应测定检测到的多种病原体相关的风险因素和临床结果。

背景：胃肠道疾病多重聚合酶链反应（GI PCR）检测已成为疑似胃肠道感染的常用方法。通过 GI PCR，患者往往同时对多种病原体检测呈阳性，但其临床意义尚不确定：这项回顾性队列研究调查了与消化道 PCR 检测出多种（而非单一）病原体相关的风险因素和临床结果。我们纳入了 2020 年至 2023 年期间接受消化道 PCR 检测并检测出一种或多种病原体的成年患者。我们将检测出多种病原体的患者与检测出单一病原体的患者进行了比较，并假设免疫抑制是检测出多种病原体的一个风险因素。我们进一步假设，在消化道 PCR 检测后的 90 天内，携带多种病原体的患者的临床结果会更差，如急诊科就诊率、死亡率、住院率或门诊就诊率都会增加：在接受检测的患者中，有 1341 人（29%）的消化道 PCR 呈阳性；其中 356 人携带多种病原体，985 人携带一种病原体。最常见的病原体包括肠致病性大肠杆菌（EPEC，27%）、诺如病毒（17%）和肠聚集性大肠杆菌（EAEC，14%）。免疫抑制与多种病原体无关（调整赔率 [aOR] 1.35，95% CI 0.96，1.86）。与多重病原体最相关的因素是西班牙裔（OR 1.86，95% CI 1.42，2.45）和慢性肾病（OR 1.69，95% CI 1.13，2.49）。有多种病原体的患者在消化道 PCR 检测后的 90 天内更有可能去急诊室就诊（40% 对 32%，P 结论）：免疫抑制与消化道 PCR 检测出多种病原体无关。检测出多种病原体会导致更差的临床结果，尽管这些影响不大。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Gut Pathogens GASTROENTEROLOGY & HEPATOLOGY-MICROBIOLOGY

CiteScore

7.70

自引率

2.40%

发文量

期刊介绍： Gut Pathogens is a fast publishing, inclusive and prominent international journal which recognizes the need for a publishing platform uniquely tailored to reflect the full breadth of research in the biology and medicine of pathogens, commensals and functional microbiota of the gut. The journal publishes basic, clinical and cutting-edge research on all aspects of the above mentioned organisms including probiotic bacteria and yeasts and their products. The scope also covers the related ecology, molecular genetics, physiology and epidemiology of these microbes. The journal actively invites timely reports on the novel aspects of genomics, metagenomics, microbiota profiling and systems biology. Gut Pathogens will also consider, at the discretion of the editors, descriptive studies identifying a new genome sequence of a gut microbe or a series of related microbes (such as those obtained from new hosts, niches, settings, outbreaks and epidemics) and those obtained from single or multiple hosts at one or different time points (chronological evolution).