Prevalence of Bacterial Enteropathogens in Transfusion-Dependent Beta-Thalassemia Children with Iron Overload

Abstract

Background: Transfusion-dependent beta-thalassemia (TDT) patients are highly susceptible to repeated infections. Iron overload and disruptions in the immune system are the main causes. Gastroenteritis symptoms are a significant cause of morbidity in this group. Objective: This study aimed to determine the prevalence of bacterial enteropathogens in TDT children presenting with gastroenteritis and to evaluate the association between bacterial growth and clinical/laboratory parameters. Methods: A cross-sectional study was conducted on 100 TDT children (≤15 years) at the Center for Genetic Blood Disorders, Al-Kut Hospital, Iraq (August 2024–January 2025). Stool samples were analyzed using culture, VITEK® 2, and 16S rRNA sequencing. Results: Bacterial growth was confirmed in 20% of patients. Isolates were predominantly Gram-negative (95%), with Escherichia coli (50%) being the most frequent. A significant association was found between bacterial growth and younger age (<10 years, P=0.001) and higher serum ferritin levels (P=0.034). Conclusion: Younger age (<10 years) and iron overload are major predictors of bacterial gastroenteritis in TDT children.