Effect of antibiotic pretreatment on bacterial engraftment after Fecal Microbiota Transplant (FMT) in IBS-D

Abstract

Fecal microbiota transplantation (FMT) is an attractive strategy to correct microbial dysbiosis in diarrhea-predominant irritable bowel syndrome (IBS-D). Although the mechanism of FMT is thought to be bacterial engraftment, the best approach to achieve engraftment after FMT in IBS-D (and other diseases) is not clear. We evaluated the effect of FMT (with or without pretreatment with antibiotics) on gut microbiome and symptoms in patients with IBS-D. In this randomized, placebo-controlled, single-center study, 44 patients with IBS-D with a least moderate severity (IBS severity scoring system, i.e., IBS-SSS, ≥175) were randomly assigned to one of four groups: single-dose oral FMT alone, single-dose oral FMT following a 7-day pretreatment course of Ciprofloxacin and Metronidazole (CM-FMT) or Rifaximin (R-FMT), or Placebo FMT. Primary endpoint was engraftment post-FMT and secondary endpoints were changes in IBS-SSS, and IBS-quality of life (IBS-QOL) at week 10. Median engraftment was significantly different among the three FMT groups ( P = .013). Engraftment post-FMT was significantly higher in the FMT alone arm (15.5%) compared to that in R-FMT group (5%, P = .04) and CM-FMT group (2.4%, P = .002). The mean change in IBS-SSS and IBS-QOL from baseline were not significantly different among the four groups or between the three FMT groups combined vs. placebo at week 10. In summary, antibiotic pretreatment significantly reduced bacterial engraftment after FMT in patients with IBS-D.

Maternal consumption of a fermented diet protects offspring against intestinal inflammation by regulating the gut microbiota

“…FMT is a critical technique for research into the functions of gut microbiota. 58 To further investigate whether the MFD affected early-life gut health by regulating the maternal gut microbiota, sow fecal microbiota was transplanted to broad-spectrum antibiotic-treated mouse dams. FMT from the MFD notably alleviated the LPS-induced decrease in α-diversity and gut Lactobacillus in both mouse dams and pups.…”

Characterization and diagnostic value of the gut microbial composition in patients with minimal change disease

“…Therefore, more and more animal experiments showed that gut microbiome interventions can treat or delay the disease ( Bermudez-Martin et al, 2021 ; Rao et al, 2021 ). Clinical trials found FMT to be effective for diarrhea-predominant irritable bowel syndrome ( Singh et al, 2022 ). Recently, FMT has also been used to treat membranous nephropathy as mentioned in a case report ( Zhou et al, 2021 ).…”

Fecal Microbiota Transplant for Hematologic and Oncologic Diseases: Principle and Practice

“…The aim of the antibiotics is to decrease the abundance of C. difficile load and to create space for the establishment of the transplanted donor microbes. Routine administration of oral antibiotics in the absence of active colitis is generally not recommended due to concerns of diminished efficacy, especially in patients with diarrhea-predominant irritable bowel disease, in which antibiotic pretreatment has been shown to significantly reduce bacterial engraftment [11]. Bowel preparation with two to three liters of oral polyethylene glycol with electrolyte purgative is carried out on the day prior to FMT.…”