Background: Diarrhea is one of the common gastrointestinal (GI) adverse events after solid organ transplantation. Diarrhea may be caused by infectious or non-infectious etiology. The infectious etiology of diarrhea varies according to the location and duration of diarrhea. Non-infectious etiologies include drugs, inflammatory bowel disease, neoplasia. The objective of this study was to evaluate the etiological profile of diarrhea in solid organ transplant recipients presenting to a tertiary care center in Southern India.Methods: This was a retrospective analysis of prospectively collected data of all solid organ transplantation recipients referred to the Department of Medical Gastroenterology for evaluation of diarrhea from April 2012 till May 2014. All patients had stool evaluated by wet mount examination, modified acid fast (AFB) stain, trichrome stain, culture, and Clostridium difficile toxin assay. EDTA plasma was collected for quantitative Cytomegalovirus (CMV) detection by real-time PCR. If the diarrhea was acute (<2 wk), and no etiological agent was identified, empirical antibiotic therapy was instituted and followed up. If persistent or chronic diarrhea (>2-4 wk), endoscopic evaluation (upper GI endoscopy and/or colonoscopy with biopsies), depending on the clinical type of diarrhea was done. If no specific etiological diagnosis was established after endoscopic evaluation, breath test for SIBO and celiac serology were done. If no specific etiology was identified after the above investigations, dose of immunosuppressive drugs was reduced. If diarrhea responded to dose reduction, it was considered to be drug related.Results: Fifty-eight episodes of diarrhea occurred in 55 solid organ transplant recipients during the study period. Renal transplant recipients constituted the majority (70%). Most (79%) of patients included in the study had their transplant > 6 mo ago.Infective diarrhea was the etiology in 46%, drug-related diarrhea in 29.3%. No specific etiology was identified in 22.4% of patients. Parasites accounted for 69% of all
CDC) for surgical site infection surveillance. For the calculation of the numbers of operations per 100,000 inhabitants the Hungarian Central Statistics Office's yearly population data was used.Results: Beside the generally monitored categories, like Caesarean section, cholecystectomy, colon surgery and hip prosthesis (with 322.3, 240.7, 144.4 and 122.9 operations per 100000 per year), other, rarely under surveillance operations, frequency was high (herniorrhaphy, exploratory laparotomy, ovarian and breast surgery with 480.6, 282, 131.1 and 114.3 operations per 100000 per year, respectively). Operations with potentially higher infection rates as limb amputation, appendix surgery and hysterectomy (abdominal and vaginal combined) were also frequently performed (102.8, 100.8 and 99 operations per 100000 per year). As known, number of laminectomy, knee prosthesis, cardiac and bypass operations are also considerable, but patients often undergo thoracic, (para)thyroid, small bowel surgery and craniotomy too.Conclusion: Taking into account the high numbers of certain surgical procedures even with low infection rates they can affect numerous patients. Under surveillance elevated attention could force early detection of infection or even more careful application of preventive measures. Surveillance of frequent operation categories with limited number of procedure types involved has to be considered on national or even on European level, e.g. herniorrhaphy, ovarian surgery.
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