Background: Acute respiratory infections are the leading cause of hospitalization and death at all ages. Although most of these infections are caused by viruses, the presentation is clinically indistinguishable from infections caused by bacteria. There are multiple methods to diagnose both viral and bacterial infections. Recently, polymerase chain reaction (PCR)-based tests have been used, which have the potential to rapidly identify multiple agents/pathogens with high sensitivity. Taking in consideration that the immunosuppressed patients are at a higher risk for infections and that clinical presentation might be sometimes obscure, an early diagnosis and specific treatment would be crucial for this group of patients. The aim of our study is to analyze the multiplex PCR results of the hospitalized solid organ transplant patients and the effect the result has on prognosis and mortality.
Methods: The solid organ transplant patients (liver, kidney and heart) who were hospitalized in our center and had a respiratory multiplex PCR due to respiratory symptoms were included in our study. The time period for patient inclusion was 1 January 2023 to 31 January 2024. The ethical committee approved the study.
Results: There were 44 patients who were included in our study (29 kidney, 9 liver and 6 heart transplant receivers). The average age was 47.4 ± 15.8 years. 27 of them (61.4%) were male and 3 patients had undergone transplant twice. 29 of patients (66%) had a living donor whereas the rest had a cadaveric one. The presence of organ rejection was 31% in those who had a living donor whereas in those who had a cadaveric donor it was 50%.  Only 15 patients had a positive result for any of the pathogens included in the multiplex PCR. The most common identified pathogens were: rhinovirus (46.6%), influenza A H1N1 subtype (20%), SARS-CoV-2 (13.3%). The other positive results included RSV A/B, Bocavirus, Human metapneumovirus A/B, Adenovirus and Coronavirus HKU1. 2 patients had 2 pathogens positive (1 patient had RSV and influenza A, the other one had Rhinovirus and Adenovirus). When we compared the PCR positive and negative SOT patients both the percentage of ICU admission and mortality were higher in the PCR positive group (66% versus 55.2 % and 40% versus 13.8% respectively).
Conclusion: The respiratory multiplex PCR is a tool for fast diagnosis and targeted treatment in solid organ patients. The presence of a positive result was associated with a high morbidity and mortality, thus a closer follow-up and additional treatments are needed regarding that apart from influenza and SARS-CoV-2 we don’t have a specific drug or vaccine for prevention.