Decolonization of multi-drug resistant bacteria by fecal microbiota transplantation in five pediatric patients before allogeneic hematopoietic stem cell transplantation: gut microbiota profiling, infectious and clinical outcomes.

Merli, Pietro; Putignani, Lorenza; Ruggeri, Annalisa; Chierico, Federica Del; Gargiullo, Livia; Galaverna, Federica; Gaspari, Stefania; Pagliara, Daria; Russo, Alessandra; Pane, Stefania; Strocchio, Luisa; Algeri, Mattia; Rea, Francesca; Romeo, Erminia; Bernaschi, Paola; Muda, Andrea Onetti; Dallapiccola, Bruno; Locatelli, Franco

doi:10.3324/haematol.2019.244210

Cited by 22 publications

(19 citation statements)

References 15 publications

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“…Similarly, Battipaglia et al successfully eradicated CRE/VRE after FMT in 7 of 10 patients with hematologic malignancies, before or after allo-HCST [ 53 ]. More recently, Merli et al showed that MDRB decolonization was achieved in four of five (80%) pediatric patients before allo-HSCT by FMT, within 1 week [ 54 ]. These reports supported not only FMT efficacy but also demonstrated that FMT in allo-HSCT settings was safe and tolerable.…”

Section: Discussionmentioning

confidence: 99%

Tandem fecal microbiota transplantation cycles in an allogeneic hematopoietic stem cell transplant recipient targeting carbapenem-resistant Enterobacteriaceae colonization: a case report and literature review

Su¹,

Luo²,

Yu³

et al. 2021

Eur J Med Res

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Background Due to limited antibiotic options, carbapenem-resistant Enterobacteriaceae (CRE) infections are associated with high non-relapse mortality after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Also, intestinal CRE colonization is a risk factor for subsequent CRE infection. Several clinical studies have reported successful fecal microbiota transplantation (FMT) for the gut decontamination of a variety of multidrug-resistant bacteria (MDRB), even in immunosuppressed patients. Similarly, other studies have also indicated that multiple FMTs may increase or lead to successful therapeutic outcomes. Case presentation We report CRE colonization in an allo-HSCT patient with recurrent CRE infections, and its successful eradication using tandem FMT cycles at 488 days after allo-HSCT. We also performed a comprehensive microbiota analysis. No acute or delayed adverse events (AEs) were observed. The patient remained clinically stable with CRE-negative stool culture at 26-month follow-up. Our analyses also showed some gut microbiota reconstruction. We also reviewed the current literature on decolonization strategies for CRE. Conclusions CRE colonization led to a high no-relapse mortality after allo-HSCT; however, well-established decolonization strategies are currently lacking. The successful decolonization of this patient suggests that multiple FMT cycles may be potential options for CRE decolonization.

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Section: Discussionmentioning

confidence: 99%

Tandem fecal microbiota transplantation cycles in an allogeneic hematopoietic stem cell transplant recipient targeting carbapenem-resistant Enterobacteriaceae colonization: a case report and literature review

Su¹,

Luo²,

Yu³

et al. 2021

Eur J Med Res

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“…Compelling evidence shows that the gut microbiota has a role in the development of graft-versus-host disease (GvHD) both in adult and pediatric patients [92,93], but the exact mechanisms of this relationship need to be elucidated [94]. In this context, the manipulation of the gut microbiota, through pharmacologic modification/decontamination [95,96] or fecal microbiota transplantation (FMT) [97,98], may shape the microbiota composition and modulate immune responses after HSCT to benefit the host. Changes in gut microbiota in patients treated by GT are another area of active investigation.…”

Section: Immunodeficiencies Affecting Cellular and Humoral Immunitymentioning

confidence: 99%

Gut Microbiota–Host Interactions in Inborn Errors of Immunity

Castagnoli

Pala

Bosticardo

et al. 2021

IJMS

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Inborn errors of immunity (IEI) are a group of disorders that are mostly caused by genetic mutations affecting immune host defense and immune regulation. Although IEI present with a wide spectrum of clinical features, in about one third of them various degrees of gastrointestinal (GI) involvement have been described and for some IEI the GI manifestations represent the main and peculiar clinical feature. The microbiome plays critical roles in the education and function of the host’s innate and adaptive immune system, and imbalances in microbiota-immunity interactions can contribute to intestinal pathogenesis. Microbial dysbiosis combined to the impairment of immunosurveillance and immune dysfunction in IEI, may favor mucosal permeability and lead to inflammation. Here we review how immune homeostasis between commensals and the host is established in the gut, and how these mechanisms can be disrupted in the context of primary immunodeficiencies. Additionally, we highlight key aspects of the first studies on gut microbiome in patients affected by IEI and discuss how gut microbiome could be harnessed as a therapeutic approach in these diseases.

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“…The procedure had a good safety profile; however, long-term colonization was not achieved in four out of five patients. 75 Several practical and microbiological issues arise when contemplating FMT in pediatric allogeneic HSCT, and they need to be addressed in the near future to optimize its use in clinical practice. Exact indications of FMT, source of fecal material, donor screening, route of administration, use of antibiotics, and safety profile are the most glaring issues to be examined.…”

Section: The Challenge Of Fecal Microbiota Transplantation In Childrenmentioning

confidence: 99%

The gut microbiome in pediatric patients undergoing allogeneic hematopoietic stem cell transplantation

Masetti

Zama

Leardini

et al. 2020

Pediatric Blood & Cancer

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The gut microbiome (GM) has been associated with different clinical outcomes in the context of allogeneic hematopoietic stem cell transplantation (HSCT). Large multicenter cohort studies in adults have found significant correlations with overall survival, relapse, and incidence of complications. Moreover, GM is already a promising target for therapeutic interventions. However, few data are available in children, a population presenting unique features and challenges. During childhood, the GM evolves rapidly with large structural fluctuations, alongside with the maturation of the immune system. Furthermore, the HSCT procedure presents significant differences in children. These considerations underline the importance of a specific focus on the pediatric setting, and the role of GM and its age-dependent trajectory in influencing the immunity reconstitution and clinical outcomes. This review provides a comprehensive overview of the available evidence in the field of GM and pediatric HSCT, highlighting age-specific issues and discussing GM-based therapeutic approaches.

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Decolonization of multi-drug resistant bacteria by fecal microbiota transplantation in five pediatric patients before allogeneic hematopoietic stem cell transplantation: gut microbiota profiling, infectious and clinical outcomes.

Cited by 22 publications

References 15 publications

Tandem fecal microbiota transplantation cycles in an allogeneic hematopoietic stem cell transplant recipient targeting carbapenem-resistant Enterobacteriaceae colonization: a case report and literature review

Tandem fecal microbiota transplantation cycles in an allogeneic hematopoietic stem cell transplant recipient targeting carbapenem-resistant Enterobacteriaceae colonization: a case report and literature review

Gut Microbiota–Host Interactions in Inborn Errors of Immunity

The gut microbiome in pediatric patients undergoing allogeneic hematopoietic stem cell transplantation

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