|Farrell, John - University Of Illinois|
Submitted to: Meeting Abstract
Publication Type: Abstract Only
Publication Acceptance Date: 6/2/2015
Publication Date: 6/2/2015
Citation: Farrell, J.J., Kurtzman, C.P. 2015. Saccharomyces cerevisiae colonization associated with fecal microbiota treatment failure [abstract].
Technical Abstract: Background: Fecal microbiota therapy (FMT) has emerged as the gold standard for treatment of persistent, symptomatic Clostridium difficile infection (CDI) that does not respond to conventional antimicrobial treatment. Probiotics are commonly recommended in addition to antimicrobial treatment for CDI and/or in conjunction with FMT. Nosocomial transmission of disseminated Saccharomyces cerevisiae infection in bone marrow transplant patients has been described, but failure of FMT associated with Saccharomyces enteric colonization has not previously been described. Methods: An 86-year old women with history of recurrent urinary tract infections received FMT for persistent symptoms of CDI despite medical treatment with oral metronidazole followed by oral vancomycin. She was concurrently receiving a daily oral probiotic treatment containing Saccharomyces sp. Fungal stool cultures were performed on stool samples obtained before and 30 days following FMT by inoculating inhibitory mold agar (Remel Products; Thermo Fisher Scientific, USA) with stool obtained by rectal swab. C. difficile toxin B PCR (GeneXpert®, Cepheid, USA) was also performed on both stool samples. Yeast recovered in culture was identified by D1/D2 LSU rRNA gene sequence. Blood and urine cultures were performed prior to FMT, but no antimicrobial treatment directed at bacteria other than Clostridium difficile was administered. Results: C. difficile toxin B PCR was positive for all stool specimens. Yeast identified as Saccharomyces cerevisiae grew in both stool cultures. The yeast identification was confirmed by D1/D2 LSU rRNA gene sequence. No other enteric organisms were recovered in stool culture. Two sets of blood cultures had no microbial growth; Swarming Proteus mirabilis grew in urine. The Proteus identification was confirmed by automated Vitek 2™ system (BioMérieux, France). Conclusions: Saccharomyces cerevisiae was cultured from the patient’s stool before and after FMT. The patient continued to experience symptoms of CDI following FMT and repeat C. difficile toxin PCR testing confirmed persistent CDI. The patient was receiving daily probiotic treatment containing Saccharomyces sp. Saccharomyces based probiotic treatment was not beneficial for the patient and may have contributed to failure of FMT.