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Donor feces infusion for eradication of Extended Spectrum beta-Lactamase producing Escherichia coli in a patient with end stage renal disease

2014; Elsevier BV; Volume: 20; Issue: 11 Linguagem: Inglês

10.1111/1469-0691.12683

1469-0691

Ramandeep Singh, Els van Nood, Max Nieuwdorp, B. van Dam, Ineke J. M. ten Berge, Suzanne E. Geerlings, Fréderike J. Bemelman,

Urinary Tract Infections Management

In an attempt to decolonise the patient from the ESBL producing E. coli, he underwent donor feces infusion in May 2013. Prior to this intervention, the presence of ESBL producing E. coli in the large intestine was again confirmed by a positive rectal culture. In addition his throat and perineum were also screened for the presence of ESBL producing Enterobacteriaceae, but both were negative. Culture of the urine was not possible because of the anuric condition of the patient. 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 6 h 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 2 days after donor feces infusion the patient experienced mild diarrhoea and abdominal cramps, but no other adverse events occurred. Follow-up ESBL swab cultures of the rectum, perineum and throat were taken at week one, two, four, and twelve after the donor feces infusion. During these four follow-up time points the ESBL cultures of the