부산대학교 도서관

Summary Background On June 13, 2019, the US Food and Drug Administration issued a warning after transfer of faeces containing an extended-spectrum [beta]-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. Author Affiliation: (a) Department of Medical Microbiology, Leiden University Medical Center, Leiden, Netherlands (b) Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, Netherlands (c) Department of Biobanking, Leiden University Medical Center, Leiden, Netherlands (d) Department of Gastroenterology, Haaglanden Medical Center, The Hague, Netherlands * Correspondence to: Prof Ed J Kuijper, Department of Medical Microbiology, Leiden University Medical Center, 2333ZA Leiden, Netherlands (footnote)* Contributed equally (footnote)[Dagger] Members are listed at the end of the paper Byline: Karuna E W Vendrik, MD (a), Elisabeth M Terveer, MD (a), Prof Ed J Kuijper, PhD [e.j.kuijper@lumc.nl] (a), Sam Nooij, MSc (a), Eline Boeije-Koppenol, MSc (a), Ingrid M J G Sanders, MSc (a), Emilie van Lingen, MD (b), Prof Hein W Verspaget, PhD (b,c), Eric K L Berssenbrugge (a), Josbert J Keller, PhD (b,d), Joffrey van Prehn, PhD (a), Eduard J. Kuijper, Josbert J. Keller, Elisabeth M. Terveer, Joffrey van Prehn, Emilie van Lingen, Eline Boeije-Koppenol, Karuna E.W. Vendrik, Eric K.L. Berssenbrugge, Hein W. Verspaget, Martijn P. Bauer, Abraham Goorhuis, Els van Nood, Chris J.J. Mulder, Rogier Ooijevaar, Yvette van Beurden, Christina M.J.E. Vandenbroucke-Grauls