Uropathogen transfer via FMT

Fecal Microbiota Transplantation (FMT) has been reported to decrease the incidence of recurrent urinary tract infections (UTIs), presumably by restoring microbiome diversity and/or uropathogen competition. We report a 16-year-old female with recurrent UTIs caused by multi-drug resistant Klebsiella pneumonia , for which frequent intravenous broad-spectrum antibiotic treatment was necessary. The patient was treated with FMT from a well screened healthy donor without multi-drug resistant bacteria in the feces. After FMT, she developed several UTIs with an antibiotic susceptible Escherichia coli that could be treated orally. The uropathogenic E. coli could be cultured from donor feces and whole genome sequencing confirmed donor to recipient transmission. Our observation should stimulate discussion on long term follow up of all infections after FMT and donor feces screening for antibiotic susceptible Enterobacterales.