Lancet子刊:避免FMT传播多重耐药菌的筛查流程
创作:吴芹 审核:mildbreeze 2020年12月31日
  • 评估某粪便银行的筛查流程能否防止含耐多药微生物(MDRO)的粪便被用于FMT;
  • 该流程包括:每3个月筛查供体+根据国外旅行史等情况安排额外筛查,并对粪便悬液进行3个月隔离保存直至确定MDRO阴性方可使用;
  • 66名供体中有17%在多次筛查中曾出现过MDRO阳性(包括16名活跃供体中的4名);
  • 检测到的19个MDRO中,74%为产ESBL大肠杆菌;
  • 对通过该流程批准使用的粪便悬液中的170份进行检测,未发现MDRO;
  • 该流程可有效防止MDRO从供体传播给受体。
主编推荐语
mildbreeze
在粪菌移植(FMT)临床实践中,对捐赠的粪便及其供体进行筛查,是确保临床安全性的重要环节。The Lancet Infectious Diseases上发表的一项回顾性队列研究,评估了荷兰供体粪便银行采用的筛查方案对于防止多重耐药微生物从供体传递给受体的有效性,相关流程和结果可供粪菌库管理者和临床专业人士参考。
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Periodic screening of donor faeces with a quarantine period to prevent transmission of multidrug-resistant organisms during faecal microbiota transplantation: a retrospective cohort study

定期筛查供体粪便并使用隔离期,以预防粪菌移植期间的耐多药微生物传播:一项回顾性队列研究

10.1016/S1473-3099(20)30473-4

2020-12-01, Article

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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.

First Authors:
Karuna E W Vendrik

Correspondence Authors:
Ed J Kuijper

All Authors:
Karuna E W Vendrik,Elisabeth M Terveer,Ed J Kuijper,Sam Nooij,Eline Boeije-Koppenol,Ingrid M J G Sanders,Emilie van Lingen,Hein W Verspaget,Eric K L Berssenbrugge,Josbert J Keller,Joffrey van Prehn,on behalf of theNetherlands Donor Faeces Bank Study Group

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