Karuna E W Vendrik1, Elisabeth M Terveer1, Ed J Kuijper2, Sam Nooij1, Eline Boeije-Koppenol1, Ingrid M J G Sanders1, Emilie van Lingen3, Hein W Verspaget4, Eric K L Berssenbrugge1, Josbert J Keller5, Joffrey van Prehn1. 1. Department of Medical Microbiology, Leiden University Medical Center, Leiden, Netherlands. 2. Department of Medical Microbiology, Leiden University Medical Center, Leiden, Netherlands. Electronic address: e.j.kuijper@lumc.nl. 3. Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, Netherlands. 4. Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, Netherlands; Department of Biobanking, Leiden University Medical Center, Leiden, Netherlands. 5. Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, Netherlands; Department of Gastroenterology, Haaglanden Medical Center, The Hague, Netherlands.
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.
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.
Authors: Yusuf Wada; Ahmad Adebayo Irekeola; Engku Nur Syafirah E A R; Wardah Yusof; Lee Lih Huey; Suwaiba Ladan Muhammad; Azian Harun; Chan Yean Yean; Abdul Rahman Zaidah Journal: Antibiotics (Basel) Date: 2021-01-31
Authors: Simon Mark Dahl Baunwall; Elisabeth M Terveer; Jens Frederik Dahlerup; Christian Erikstrup; Perttu Arkkila; Maria Jgt Vehreschild; Gianluca Ianiro; Antonio Gasbarrini; Harry Sokol; Patrizia K Kump; Reetta Satokari; Danny De Looze; Séverine Vermeire; Radislav Nakov; Jan Brezina; Morten Helms; Jens Kjeldsen; Anne A Rode; Sabrina Just Kousgaard; Laurent Alric; Caroline Trang-Poisson; Julien Scanzi; Alexander Link; Andreas Stallmach; Juozas Kupcinskas; Peter Holger Johnsen; Kjetil Garborg; Eugenia Sánchez Rodríguez; Lena Serrander; Robert J Brummer; Katerina Tatiana Galpérine; Simon D Goldenberg; Benjamin H Mullish; Horace Rt Williams; Tariq H Iqbal; Cyriel Ponsioen; Ed J Kuijper; Giovanni Cammarota; Josbert J Keller; Christian Lodberg Hvas Journal: Lancet Reg Health Eur Date: 2021-07-19
Authors: Karuna E W Vendrik; Tim G J de Meij; Arend Bökenkamp; Rogier E Ooijevaar; Bas Groenewegen; Antoni P A Hendrickx; Elisabeth M Terveer; Ed J Kuijper; Joffrey van Prehn Journal: Open Forum Infect Dis Date: 2022-06-29 Impact factor: 4.423