Service of Infectious Diseases, Lausanne University Hospital, Lausanne, Switzerland.
French Group of Fecal Microbiota Transplantation (GFTF), France.
PLoS One. 2023 Jun 29;18(6):e0287847. doi: 10.1371/journal.pone.0287847. eCollection 2023.
Fecal Microbiota Transplantation (FMT) has become the preferred treatment for recurrent Clostridioides difficile Infections (CDI). However, donor screening is a complex process that varies between countries. The primary objective of screening is to prevent the transfer of potential pathogens from the donor to the recipient via feces. Many guidelines recommend Cytomegalovirus (CMV) testing as part of donor screening, but is the risk of CMV transmission well supported by evidence?
MATERIALS/METHODS: A French prospective cross-sectional multicenter single-arm study estimated the frequency of detection of CMV in the stool of voluntary healthy donors selected for FMT. All preselected donors were tested for CMV antibodies in blood, and if positive, CMV DNA PCR was performed on whole blood and stool. For samples CMV positive in stool PCR, or case of serological markers positive for IgM, we planned isolation of CMV in cell culture.
From June 1, 2016, to July 31, 2017, 500 healthy donors (250 per center) were recruited and 483 included. Of these, 301 were CMV seronegative, and 182 tested positive for CMV IgM and/or IgG. Stool CMV PCR was performed in 162 donors. In two cases, the initial analysis was positive, but below the limit of quantification. Repeated PCR tests using Siemens and Altostar assays were negative. No infectious CMV could be detected in cell culture of these two samples and in the stool of 6 CMV IgM-positive donors.
Our study shows that healthy volunteers with positive CMV serology do not shed CMV DNA in their stool, as detected by PCR or cell culture. This study provides another argument to remove CMV screening for FMT donors.
粪便微生物群移植（FMT）已成为复发性艰难梭菌感染（CDI）的首选治疗方法。然而，供体筛选是一个复杂的过程，在不同国家之间存在差异。筛选的主要目的是通过粪便防止潜在病原体从供体转移到受者。许多指南建议将巨细胞病毒（CMV）检测作为供体筛选的一部分，但 CMV 传播的风险是否有充分的证据支持？
材料/方法：一项法国前瞻性横断面多中心单臂研究估计了从选择进行 FMT 的自愿健康供体粪便中检测到 CMV 的频率。所有预选供体均进行了血液 CMV 抗体检测，如果阳性，则对全血和粪便进行 CMV DNA PCR 检测。对于粪便 PCR 中 CMV 阳性的样本，或血清学标志物 IgM 阳性的样本，我们计划在细胞培养中分离 CMV。
从 2016 年 6 月 1 日至 2017 年 7 月 31 日，招募了 500 名健康供体（每个中心 250 名），并纳入了 483 名供体。其中 301 名供体 CMV 血清学阴性，182 名供体 CMV IgM 和/或 IgG 阳性。对 162 名供体进行了粪便 CMV PCR 检测。在两种情况下，初始分析呈阳性，但低于定量下限。使用西门子和 Altostar 检测方法重复 PCR 检测均为阴性。在这两个样本的细胞培养物和 6 名 CMV IgM 阳性供体的粪便中均未检测到感染性 CMV。
我们的研究表明，CMV 血清学阳性的健康志愿者粪便中未检测到 CMV DNA，无论是通过 PCR 还是细胞培养。本研究为去除 FMT 供体的 CMV 筛查提供了另一个论据。
