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      Drug-Resistant E. coli Bacteremia Transmitted by Fecal Microbiota Transplant

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          Abstract

          <p class="first" id="d3371400e125">Fecal microbiota transplantation (FMT) is an emerging therapy for recurrent or refractory Clostridioides difficile infection and is being actively investigated for other conditions. We describe two patients in whom extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli bacteremia occurred after they had undergone FMT in two independent clinical trials; both cases were linked to the same stool donor by means of genomic sequencing. One of the patients died. Enhanced donor screening to limit the transmission of microorganisms that could lead to adverse infectious events and continued vigilance to define the benefits and risks of FMT across different patient populations are warranted. </p>

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          European consensus conference on faecal microbiota transplantation in clinical practice

          Giovanni Cammarota, Gianluca Ianiro, Herbert Tilg … (2017)
          Faecal microbiota transplantation (FMT) is an important therapeutic option for Clostridium difficile infection. Promising findings suggest that FMT may play a role also in the management of other disorders associated with the alteration of gut microbiota. Although the health community is assessing FMT with renewed interest and patients are becoming more aware, there are technical and logistical issues in establishing such a non-standardised treatment into the clinical practice with safety and proper governance. In view of this, an evidence-based recommendation is needed to drive the practical implementation of FMT. In this European Consensus Conference, 28 experts from 10 countries collaborated, in separate working groups and through an evidence-based process, to provide statements on the following key issues: FMT indications; donor selection; preparation of faecal material; clinical management and faecal delivery and basic requirements for implementing an FMT centre. Statements developed by each working group were evaluated and voted by all members, first through an electronic Delphi process, and then in a plenary consensus conference. The recommendations were released according to best available evidence, in order to act as guidance for physicians who plan to implement FMT, aiming at supporting the broad availability of the procedure, discussing other issues relevant to FMT and promoting future clinical research in the area of gut microbiota manipulation. This consensus report strongly recommends the implementation of FMT centres for the treatment of C. difficile infection as well as traces the guidelines of technicality, regulatory, administrative and laboratory requirements.
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            Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA)

            Dale Gerding, Karen C Carroll, Stuart Johnson … (2018)
            A panel of experts was convened by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) to update the 2010 clinical practice guideline on Clostridium difficile infection (CDI) in adults. The update, which has incorporated recommendations for children (following the adult recommendations for epidemiology, diagnosis, and treatment), includes significant changes in the management of this infection and reflects the evolving controversy over best methods for diagnosis. Clostridium difficile remains the most important cause of healthcare-associated diarrhea and has become the most commonly identified cause of healthcare-associated infection in adults in the United States. Moreover, C. difficile has established itself as an important community pathogen. Although the prevalence of the epidemic and virulent ribotype 027 strain has declined markedly along with overall CDI rates in parts of Europe, it remains one of the most commonly identified strains in the United States where it causes a sizable minority of CDIs, especially healthcare-associated CDIs. This guideline updates recommendations regarding epidemiology, diagnosis, treatment, infection prevention, and environmental management.
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              Oral, capsulized, frozen fecal microbiota transplantation for relapsing Clostridium difficile infection.

              Ilan Youngster, George Russell, Christina Pindar … (2014)
              Fecal microbiota transplantation (FMT) has been shown to be effective in treating relapsing or refractory Clostridium difficile infection, but practical barriers and safety concerns have prevented its widespread use.
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                Author and article information

                Journal
                Title: New England Journal of Medicine
                Abbreviated Title: N Engl J Med
                Publisher: Massachusetts Medical Society
                ISSN (Print): 0028-4793
                ISSN (Electronic): 1533-4406
                Publication date Created: November 21 2019
                Publication date (Print): November 21 2019
                Volume: 381
                Issue: 21
                Pages: 2043-2050
                Affiliations
                [1 ]From the Blood and Marrow Transplant Program (Z.D., Y.-B.C.), the Liver Center, Division of Gastroenterology (P.P.B., R.T.C.), and the Division of Infectious Diseases (M.T.S., M.K.M., S.T., E.L.H.), Massachusetts General Hospital, Harvard Medical School (Z.D., P.P.B., M.T.S., M.K.M., S.T., R.T.C., Y.-B.C., E.L.H.), and Day Zero Diagnostics (M.R.A.S., M.H.H.) — all in Boston.
                Article
                DOI: 10.1056/NEJMoa1910437
                PubMed ID: 31665575
                SO-VID: 172e9b2f-a0e2-4457-bce4-4918a5a9dd71
                Copyright © © 2019
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