Fecal Microbiota Transplantation Influences Procarcinogenic Escherichia coli in Recipient Recurrent Clostridioides difficile Patients
Sam Nooij, Quinten R. Ducarmon, Jeroen F. J. Laros, Romy D. Zwittink, Jason M. Norman, Wiep Klaas Smits, Hein W. Verspaget, Josbert J. Keller, Elisabeth M. Terveer, Ed J. Kuijper
Abstract
Background & Aims Patients with multiple recurrent Clostridioides difficile infection (rCDI) have a disturbed gut microbiota that can be restored by fecal microbiota transplantation (FMT). Despite extensive screening, healthy feces donors may carry bacteria in their intestinal tract that could have long-term health effects, such as potentially procarcinogenic polyketide synthase-positive ( pks + ) Escherichia coli . Here, we aim to determine whether the pks abundance and persistence of pks + E coli is influenced by pks status of the donor feces. Methods In a cohort of 49 patients with rCDI treated with FMT and matching donor samples—the largest cohort of its kind, to our knowledge—we retrospectively screened fecal metagenomes for pks + E coli and compared the presence of pks in patients before and after treatment and to their respective donors. Results The pks island was more prevalent ( P = .026) and abundant ( P < .001) in patients with rCDI (pre-FMT, 27 of 49 [55%]; median, 0.46 reads per kilobase per million [RPKM] pks ) than in healthy donors (3 of 8 donors [37.5%], 11 of 38 samples [29%]; median, 0.01 RPKM pks ). The pks status of patients post-FMT depended on the pks status of the donor suspension with which the patient was treated ( P = .046). Particularly, persistence (8 of 9 cases) or clearance (13 of 18) of pks + E coli in pks + patients was correlated to pks in the donor ( P = .004). Conclusions We conclude that FMT contributes to pks + E coli persistence or eradication in patients with rCDI but that donor-to-patient transmission of pks + E coli is unlikely.