UvA-DARE (Digital Academic Repository) Fecal Microbiota Transplantation: Clinical and experimental studies van Nood, E. Link to publication Citation for published version (APA): van Nood, E. (2015). Fecal Microbiota Transplantation: Clinical and experimental studies General rights It is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), other than for strictly personal, individual use, unless the work is under an open content license (like Creative Commons). Disclaimer/Complaints regulations If you believe that digital publication of certain material infringes any of your rights or (privacy) interests, please let the Library know, stating your reasons. In case of a legitimate complaint, the Library will make the material inaccessible and/or remove it from the website. Please Ask the Library: http://uba.uva.nl/en/contact, or a letter to: Library of the University of Amsterdam, Secretariat, Singel 425, 1012 WP Amsterdam, The Netherlands. You will be contacted as soon as possible. UvA-DARE is a service provided by the library of the University of Amsterdam (http://dare.uva.nl) Download date: 04 Jul 2018
Fecal Microbiota Transplantation for eradication of Extended Spectrum beta-lactamase producing Escherichia coli in a patient with end stage renal disease. R. Singh, E. van Nood, M. Nieuwdorp, B. van Dam, I. J.M. ten Berge S.E. Geerlings and F.J. Bemelman Clin Microbiol Infect. 2014 ;11:O977-8
A 60-year-old Caucasian male with end stage renal disease resulting from longstanding hypertension underwent his first post-mortal renal allotransplantation in 2000, which was complicated by a steroid resistant acute rejection episode and subsequently resulted in transplantectomy within three months thereafter. In 2003, he underwent his second post-mortal renal allotransplantation. From 2006 onwards he suffered from recurrent episodes of transplant pyelonephritis. In the following years his serum creatinine rose slowly and proteinuria developed. In 2008 a biopsy of the renal allograft showed chronic interstitial damage and tubular atrophy compatible with chronic rejection and pyelonephritis. Between 2011 and 2012 he was admitted eight times for recurrent episodes of transplant pyelonephritis caused by an Extended Spectrum beta- Lactamase (ESBL) producing Escherichia coli (E. coli). Each episode was associated with an acute further decline in renal function that only partially recovered upon treatment. In 2012 the patient reached end stage renal disease due to graft failure caused by recurrent transplant pyelonephritis and chronic allograft nephropathy. He started with peritoneal dialysis and underwent transplantectomy. Hereafter, he remained colonized by ESBL producing E. coli in the large intestine as was shown by at least three ESBL positive swab cultures from his rectum. As the risk for recurrent pyelonephritis by ESBL producing E. coli due to persistent colonization yielded a relative contraindication for another renal transplant procedure, he was not been placed on the renal transplant waiting list. In an attempt to decolonize the patient from the ESBL producing E. coli, he underwent fecal microbiota transplantation (FMT) in May 2013. The donor feces infusion was performed according to the protocol as used in the FECAL trial. 1 In summary, donor feces were obtained from a young healthy Caucasian adult, who was periodically screened for various infectious and gastro-intestinal diseases. Feces from the donor were collected and processed within six hours after production. First, the feces were diluted with sterile saline, and then poured through unfolded gauze in a funnel, in order to obtain a solution which was free of debris and solid particles. This solution was immediately infused in the patient through a nasoduodenal tube. Donor feces infusion was preceded by full colon lavage without prior use of antibiotics. Within the first two days after donor feces infusion the patient experienced mild diarrhea and abdominal cramps, but no other adverse events occurred. Followup ESBL swab cultures of the rectum, perineum and throat were taken at week one, two, four, and twelve after the donor feces infusion. Two weeks after donor 188
FMT for eradication of ESBL producing bacteria feces infusion, all swab cultures became and remained negative during the twelve week follow-up. Thanks to this successful eradication, the patient is now on the waiting list for renal transplantation. Donor feces infusion, which is also called fecal microbiota transplantation and fecal bacteriotherapy, is an intervention that has been elaborately evaluated against Clostridium difficile (C. difficile) infection. Most published data about this intervention were case series and case reports of which systematic reviews were written. 2-4 These systematic reviews reported that fecal microbiota transplantation could be a promising intervention against C. difficile infection. Additional evidence was recently provided by the FECAL trial 1 which demonstrated in an open label randomized controlled trial that donor feces infusion is indeed very effective against recurrent C. difficile infection. Therefore we hypothesized that donor feces infusion is not only effective against C. difficile, but could also be effective against ESBL producing Enterobacteriaceae residing in the large intestine. To study this hypothesis a proof of principal study about the effectiveness of FMT for eradication of intestinal colonization by ESBL producing Enterobacteriaceae is currently being performed within our hospital. 8 189
References 1. van Nood E, Vrieze A, Nieuwdorp M et al., Duodenal infusion of donor feces for recurrent Clostridium difficile. N Engl J Med, 2013. 368(5): p. 407-15. 2. Kassam Z, Lee CH, Yuan Y, Hunt RH. Fecal microbiota transplantation for Clostridium difficile infection: systematic review and meta-analysis. Am J Gastroenterol, 2013. 108(4): p. 500-8. 3. Gough, E., H. Shaikh, and A.R. Manges, Systematic review of intestinal microbiota transplantation (fecal bacteriotherapy) for recurrent Clostridium difficile infection. Clin Infect Dis, 2011. 53(10): p. 994-1002. 4. Guo B, Harstall C, Louie T, Veldhuyzen van Zanten S, Dieleman L.A. Systematic review: faecal transplantation for the treatment of Clostridium difficile-associated disease. Aliment Pharmacol Ther, 2012. 35(8): p. 865-75. 190