1194. Predictors of Persistent Diarrhea in Norovirus Enteritis after Solid Organ Transplantation
Session: Poster Abstract Session: Transplant: Epidemiology of Infections in Transplant Patients and Other Patients with Impaired Immunity
Friday, October 9, 2015
Room: Poster Hall
Posters
  • 42x84_ID week 2015_Chong.pdf (105.7 kB)
  • Background:

    Solid organ transplant (SOT) recipients with norovirus enteritis (NVE) have more severe and protracted diarrheal illness. Predictors of persistent diarrhea are unknown.

    Methods:

    This was a retrospective chart review of SOT recipients with NVE at 2 institutions (January 2010-April 2014). NVE was defined as a positive stool norovirus (NoV) polymerase chain reaction in the presence of gastrointestinal symptoms.

    Results:

    152 SOT recipients with NVE with mean age of 31.5 years were included: 43.4% male, 34.2% pediatric patients. Allograft types: abdominal 136 (89.5%) [kidney (39.5%), liver-small bowel  (23%), other (27%)] and thoracic 16 (10.5%). Most were due to NoV genogroup 2 and co-infections were seen in 19.1% recipients. Treatment included reduction in immunosuppression in 78 (52%), nitazoxanide monotherapy in 9 (6%), enteral immunoglobulin (IG) monotherapy in 4 (3%), combined nitazoxanide and enteral IG in 5 (3%) and IVIG in 5 (3%). 134 (88%) of SOT recipients received supportive care only. Diarrhea resolved in 90 (69.8%) patients 2 weeks after therapy completion. In univariate analysis, older age (p=0.019), adults (p=0.018), nausea at diagnosis (p=0.001), vomiting at diagnosis (p=0.054) and CMV infection 90 days prior to NVE (p=0.024) were predictors of persistent diarrhea, while higher number of nitazoxanide doses administered (p=0.049) and anti-motility agent administration (p=0.022) were predictors of diarrhea resolution. Results of multivariable analysis are shown in Table 1. Propensity score analyses showed no outcome differences with nitazoxanide treatment alone or in combination with enteral IG. 

    Variables at Time of Diagnosis

    OR

    95% CI

    p-value

    Age

    1.00

    0.98-1.03

    0.781

    Nausea

    4.41

    1.75-11.15

    0.002

    CMV infection within 90 days prior to infection

    5.57

    1.12-27.63

    0.036

    Anti-motility agent administration

    0.55

    0.22-1.37

    0.197

    Table 1: Predictors of Persistent Diarrhea

    Conclusion:

    Nausea at time of diagnosis and prior CMV infection were associated with failure of diarrhea resolution. Experimental treatments (nitazoxanide alone or in combination with enteral IG) were not associated with more diarrhea resolution compared to supportive care although small number of treated patients precludes further conclusions.

    Pearlie P. Chong, MD1, David Van Duin, MD, PhD1, Jessica L. Sonderup, BS2, Wendy J. Grant, MD3, Andre C. Kalil, MD, MPH2 and Diana F. Florescu, MD2, (1)Infectious Diseases, University of North Carolina, Chapel Hill, NC, (2)Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, (3)Transplant Surgery Division, University of Nebraska Medical Center, Omaha, NE

    Disclosures:

    P. P. Chong, None

    D. Van Duin, Sanofi-Pasteur: Consultant , Consulting fee
    Scynexis: Investigator , Research support

    J. L. Sonderup, None

    W. J. Grant, None

    A. C. Kalil, None

    D. F. Florescu, Behring: Grant Investigator , Research grant and Speaker honorarium

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.