Origins of bloodstream infections following fecal microbiota transplantation: A strain-level analysis

Adi Eshel, Itai Sharon, Arnon Nagler, David Bomze, Ivetta Danylesko, Joshua A. Fein, Mika Geva, Israel Henig, Avichai Shimoni, Tsila Zuckerman, Ilan Youngster, Omry Koren, Roni Shouval

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


We observed high rates of bloodstream infections (BSIs) following fecal microbiota transplantation (FMT) for graft-versus-host-disease (33 events in 22 patients). To trace the BSIs' origin, we applied a metagenomic bioinformatic pipeline screening donor and recipient stool samples for bacteremia-causing strains in 13 cases. Offending strains were not detected in FMT donations. Enterococcus faecium, Escherichia coli, Pseudomonas aeruginosa, and Acinetobacter baumannii could be detected in stool samples before emerging in the blood. In this largest report of BSIs post-FMT, we present an approach that may be applicable for evaluating BSI origin following microbiota-based interventions. Our findings support FMT safety in immunocompromised patients but do not rule out FMT as an inducer of bacterial translocation.

Original languageEnglish
Pages (from-to)568-573
Number of pages6
JournalBlood advances
Issue number2
StatePublished - 25 Jan 2022

Bibliographical note

Publisher Copyright:
© 2022 American Society of Hematology. All rights reserved.


This work was supported by the Dahlia Greidinger Anti Cancer Fund, the Gasner Fund for Medical Research, and an institutional grant from the Chaim Sheba Medical Center. The authors thank Elvire Thouvenot-Nitzan for figure design and illustration. R.S. is supported by the American Society of Hematology Fellow Scholar Award.

FundersFunder number
Chaim Sheba Medical Center
Gasner Fund for Medical Research
National Cancer InstituteP30CA008748
American Society of Hematology
Dahlia Greidinger Anti-Cancer Fund


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