Periodic screening of donor faeces with a quarantine period to prevent transmission of multidrug-resistant organisms during faecal microbiota transplantation: a retrospective cohort study
Open accessAbstract
Background On June 13, 2019, the US Food and Drug Administration issued a warning after transfer of faeces containing an extended-spectrum β-lactamase (ESBL)-producing Escherichia coli by faecal microbiota transplantation led to bacteraemia in two immunocompromised patients. Consequently, we evaluated the effectiveness of the faeces donor-screening protocol of the Netherlands Donor Faeces Bank, which consists of screening of donors for multidrug-resistant organisms every 3 months, combined with additional screening on indication (eg, after travelling abroad) and application of a quarantine period for all faecal suspensions delivered within those 3 months.Methods We did a retrospective cohort study of data collected between Jan 1, 2015, and Oct 14, 2019, on the multidrug-resistant organism testing results of donor faeces. Additionally, we tested previously quarantined faecal suspensions approved for faecal microbiota transplantation between Dec 12, 2016, and May 1, 2019, for the presence of multidrug-resistant organisms using both aselective and selective broth enrichment media. Whole-genome sequencing with core-genome multilocus sequence typing (cgMLST) was done on all multidrug-resistant isolates.Findings Among initial screenings, six (9%) of 66 tested individuals were positive for multidrug-resistant organisms and 11 (17%) of 66 tested individuals were positive for multidrug-resistant organisms at any timepoint. Multidrug-resistant organisms were detected in four (25%) of 16 active donors, who had a median donation duration of 268 days (IQR 92 to 366). Among all screening results, 14 (74%) of 19 detected multidrug-resistant organisms were ESBL-producing E coli. 170 (49%) of 344 approved faecal suspensions had corresponding research faeces aliquots available and were tested (from 11 active donors with a median of eight [IQR five to 26] suspensions per donor). No multidrug-resistant organisms were detected in the 170 approved faecal suspensions (one-sided 95% CI 0 to 1·7). cgMLST revealed that all multidrug-resistant organisms were genetically different.Interpretation Healthy faeces donors can become colonised with multidrug-resistant organisms during donation activities. Our screening protocol did not result in approval of multidrug-resistant organism-positive faecal suspensions for microbiota transplantation.Funding None.
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A recent retrospective cohort study of collected donor feces tested for multidrug-resistant organisms showed that 6 of 66 tested individuals (9%) were positive for multidrug-resistant organisms at any timepoint.
“Furthermore, a recent retrospective cohort study of collected donor feces tested for multidrug-resistant organisms showed that 6 of 66 tested individuals (9%) were positive for multidrug-resistant organisms at any timepoint [137].”
From Gut microbiota influence immunotherapy responses: mechanisms and therapeutic strategies (2022) · cites this paper as [137]
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- Authors
- Vendrik, K. E. W., Terveer, E. M., Kuijper, E. J., Nooij, S., Boeije-Koppenol, E., Sanders, I. M. J. G., van Lingen, E., Verspaget, H. W., Berssenbrugge, E. K. L., Keller, J. J., van Prehn, J., Kuijper, E. J., Keller, J. J., Terveer, E. M., van Prehn, J., van Lingen, E., Boeije-Koppenol, E., Vendrik, K. E. W., Berssenbrugge, E. K. L., Verspaget, H. W., Bauer, M. P., Goorhuis, A., van Nood, E., Mulder, C. J. J., Ooijevaar, R., van Beurden, Y., & Vandenbroucke-Grauls, C. M. J. E.
- Affiliations
- Leiden University Medical Center (NL)
- Venue
- The Lancet Infectious Diseases
- Publisher
- Elsevier BV
- Published
- 2021-05
- Volume
- 21
- Issue
- 5
- Pages
- 711-721
- ISSN
- 1473-3099 (ISSN-L)
- OpenAlex
- W3110123112
- Cited by
- 49
- References
- 26
- Citations by year
- 2026: 5 · 2025: 9 · 2024: 13 · 2023: 9 · 2022: 3 · 2021: 9 · 2020: 1
- FWCI
- 1.83
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- The Lancet Infectious Diseases (publishedVersion)
- PubMed (publishedVersion)
- Leiden Repository (Leiden University) (submittedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion, cc-by)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Funders
- Universiteit Leiden
- ZonMw (1708810011)
- Santen
- Leids Universitair Medisch Centrum
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Medicine › Antibiotic Resistance in Bacteria
- Health Sciences › Medicine › Infectious Diseases › Clostridium difficile and Clostridium perfringens research
- Health Sciences › Medicine › Infectious Diseases › Infection Control in Healthcare
- Keywords
- fecal microbiota transplantation, donor screening, multidrug-resistant organisms, extended-spectrum beta-lactamase, Escherichia coli, quarantine period, infection control, core genome multilocus sequence typing, whole genome sequencing, colonization, transmission prevention, immunocompromised patients, travel-associated infection
- MeSH terms
- Fecal Microbiota Transplantation, Adult, Escherichia coli, Escherichia coli Infections, Feces, Female, Humans, Male, Middle Aged, Netherlands, Quarantine, Retrospective Studies, Drug Resistance, Multiple, Bacterial, Young Adult, Multilocus Sequence Typing, Microbiota
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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