Cited by 49Antibiotic Resistance in BacteriaClostridium difficile and Clostridium perfringens researchInfection Control in Healthcare

Periodic screening of donor faeces with a quarantine period to prevent transmission of multidrug-resistant organisms during faecal microbiota transplantation: a retrospective cohort study

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Vendrik, Karuna E W, Terveer, Elisabeth M, Kuijper, Ed J, Nooij, Sam, Boeije-Koppenol, Eline, Sanders, Ingrid M J G, van Lingen, Emilie, Verspaget, Hein W +19 more·2021·The Lancet Infectious Diseases

Abstract

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].”

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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
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

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