Faecal microbiota transplantation influences procarcinogenic Escherichia coli in recipient recurrent Clostridioides difficile patients.

Abstract

BACKGROUND AND AIMS\nPatients suffering from multiple recurrent Clostridioides difficile infections (rCDI) have a disturbed gut microbiota, which can be restored by faecal microbiota transplantation (FMT). Despite extensive screening, healthy faeces donors may carry bacteria in their intestinal tract that could have long-term health effects, such as potentially procarcinogenic 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 faeces.\n\n\nMETHODS\nIn a cohort of 49 rCDI patients treated with FMT and matching donor samples - the largest cohort of its kind, to our knowledge - we retrospectively screened faecal metagenomes for pks+E. coli and compared the presence of pks in patients before and after treatment, and to their respective donors.\n\n\nRESULTS\nThe pks island was more prevalent (P = .026) and abundant (P < .001) in rCDI patients (pre-FMT; 27/49 = 55%, median: 0.46 reads per kilobase per million (RPKM) pks) than in healthy donors (3/8 donors (37.5%), 11/38 samples (29%), median: 0.01 RPKM pks). The pks-status of patients post-FMT depended on the pks-status of the donor suspension by which the patient was treated (P = .046). Particularly, persistence (8/9 cases) or clearance (13/18) of pks+E. coli in pks+ patients was correlated to pks in the donor (P = .004).\n\n\nCONCLUSION\nWe conclude that FMT contributes to pks+E. coli persistence or eradication in rCDI patients, but that donor-to-patient transmission of pks+E. coli is unlikely.