Transmission and clearance of potential procarcinogenic bacteria during fecal microbiota transplantation for recurrent Clostridioides difficile

Fecal Microbiota Transplantation: Screening and Selection to Choose the Optimal Donor

“…FMT is considered a safe procedure; however, mild adverse effects attributable to FMT are reported in about one third of the recipients, such as self-limiting abdominal discomfort or changes of bowel habits, and unfortunately, about 2–6% of patients experienced serious adverse events, such as infection, relapse of pre-existing disease, or death [ 64 ]. Moreover, the difficulty of selecting the appropriate candidates is increasing due to emerging concerns, as the possibility of transmission of putative procarcinogenic bacteria [ 65 ] or the potential risk of serious life threatening infections with multi-drug resistant organisms after FMT [ 66 ]. Moreover, recent evidences showed that the efficacy of FMT in recurrent CDI treatment, in clinical trials and in other healthcare settings seems to be linked to different variables, such as the delivery methods of fecal infusate, the bowel preparation, the number of infusion, the disease severity, and in particular to the microbial diversity and composition of the transplanted stools [ 32 , 44 , 67 ].…”

Fecal Microbiota Transplantation Influences Procarcinogenic Escherichia coli in Recipient Recurrent Clostridioides difficile Patients

“…In recent years, there has been increasing attention for the causative role of gut bacteria in the development of colorectal cancer, which may pose a long-term risk. 8 In 2019, Drewes et al 9 studied transmission and clearance of putative procarcinogenic bacteria, including colibactin-encoding Escherichia coli, by FMT in 11 pediatric patients with rCDI. 9 Colibactin-producing E coli, also known as polyketide synthase-positive (pks þ ) E coli, has gained much attention lately, because it can be present in healthy and diseased people, has been used as a probiotic (strain Nissle 1917), and is now suspected to contribute to colorectal carcinogenesis.…”

“…8 In 2019, Drewes et al 9 studied transmission and clearance of putative procarcinogenic bacteria, including colibactin-encoding Escherichia coli, by FMT in 11 pediatric patients with rCDI. 9 Colibactin-producing E coli, also known as polyketide synthase-positive (pks þ ) E coli, has gained much attention lately, because it can be present in healthy and diseased people, has been used as a probiotic (strain Nissle 1917), and is now suspected to contribute to colorectal carcinogenesis. [10][11][12] The pks þ E coli carries a pks gene island of approximately 54 kilobases long, with 19 genes that encode the machinery to produce the nonribosomal peptide-polyketide hybrid genotoxin colibactin.…”

Cultivation and Genomics Prove Long-Term Colonization of Donor’s Bifidobacteria in Recurrent Clostridioides difficile Patients Treated With Fecal Microbiota Transplantation

“…Recent metagenomic studies and SNV mapping have addressed this question and indicated presence of donor strains in recipients for several months after FMT (Li et al, 2016;Kumar et al, 2017;Lee et al, 2017;Smillie et al, 2018). Recently, Drewes et al (2019) assessed the presence of bacterial virulence factors up to 6 months after FMT in eleven pediatric rCDI patients and their respective donors by fecal cultures and quantitative PCR, and the results indicated durable transmission. However, the strain verification by WGS was done only in one patient-donor-pair.…”