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High carriage rate of extended‐spectrum β‐lactamase Enterobacterales and diarrheagenic Escherichia coli in healthy donor screening for fecal microbiota transplantation

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Abstract

The safety of fecal microbiota transplantation (FMT) has been highlighted by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli bacteremia transmitted from donors and acquisition of diarrheagenic E. coli (Shiga toxin-producing E. coli (STEC) and enteropathogenic E. coli (EPEC)) via FMT. The use of donor screening criteria to lower the risk of pathogen transmission via FMT is essential. This study aimed to demonstrate the outcomes of our strict donor screening program. This study was conducted at our FMT center between January 2019 and June 2022. Our donor screening program included an initial questionnaire and subsequent blood and stool testing. We further used selective culture for third-generation cephalosporin-resistant (3GCR) Enterobacterales and multiplex PCR to detect diarrheagenic E. coli in stools. The resistance mechanisms and sequence type of 3GCR Enterobacterales were determined. A total of 742 individuals were assessed, and 583 participants (78.6%) were excluded after questionnaire. Of the remaining 159 participants undergoing stool and blood tests, 37 participants were finally qualified (5.0%, 37/742). A high fecal carriage rate of ESBL-producing Enterobacterales (35.2%, 56/159), including E. coli (n=53) and Klebsiella pneumoniae (n=5), and diarrheagenic E. coli (31.4%, 50/159), including EPEC (n=41), enteroaggregative E. coli (n=11), enterotoxigenic E. coli (n=4), and STEC (n=1), was noted. CTX-M-79 and CTX-M-15 were dominant in E. coli and K. pneumoniae, respectively. The sequence types of the ESBL-producing strains were diverse. The screening for 3GCR Enterobacterales and diarrheagenic E. coli in stool is necessary. Our findings also support the effectiveness of multiplex PCR panels in FMT donor screening programs.

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Data Availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request.

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Funding

This study was supported by grants from the Taipei Veterans General Hospital [V107E-007-1 (108), V108E-007-1 (108), V108E-007-1 (109), V110E-002-1].

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Author notes

  1. Yi-Tsung Lin and Ming-Chih Hou contributed equally to this article.

Authors and Affiliations

  1. Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

    Chien Chuang & Yi-Tsung Lin

  2. School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan

    Chien Chuang, Kuei-Chuan Lee, Yen-Po Wang, Pei-Chang Lee, Tien-En Chang, Yi-Hsiang Huang & Ming-Chih Hou

  3. Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

    Kuei-Chuan Lee, Yen-Po Wang, Pei-Chang Lee, Tien-En Chang, Yi-Hsiang Huang & Ming-Chih Hou

  4. Endoscopy Center for Diagnosis and Treatment, Taipei Veterans General Hospital, Taipei, Taiwan

    Yen-Po Wang & Tien-En Chang

  5. Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan

    Yi-Tsung Lin

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  1. Chien Chuang
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Corresponding authors

Correspondence to Yi-Tsung Lin or Ming-Chih Hou.

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The study was approved by the Institution Review Board of Taipei Veterans General Hospital. All subjects that participated in this study gave a written informed consent.

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The authors declare no competing interests.

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The funders had no role in study design, data collection and interpretation, or the decision to submit the work for publication.

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The preliminary data of this study were presented at the annual meeting of the Infectious Diseases Society of Taiwan in March 2022.

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Chuang, C., Lee, KC., Wang, YP. et al. High carriage rate of extended‐spectrum β‐lactamase Enterobacterales and diarrheagenic Escherichia coli in healthy donor screening for fecal microbiota transplantation. Eur J Clin Microbiol Infect Dis 42, 1103–1113 (2023). https://doi.org/10.1007/s10096-023-04644-3

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