Faecal microbiota replacement to eradicate antimicrobial resistant bacteria in the intestinal tract – a systematic review

Abstract

Purpose of review Antimicrobial resistance is a rising threat to global health and is associated with increased mortality. Intestinal colonisation with multidrug-resistant organisms (MDRO) can precede invasive infection and facilitates spread within communities and hospitals. Novel decolonisation strategies, such as faecal microbiota transplantation (FMT), are being explored. The purpose of this review is to provide an update on how the field of FMT for MDRO decolonisation has developed during the past year and to assess the efficacy of FMT for intestinal MDRO decolonisation. Recent findings Since 2020, seven highly heterogenous, small, nonrandomised cohort studies and five case reports have been published. In line with previous literature, decolonisation rates ranged from 20 to 90% between studies and were slightly higher for carbapenem-resistant Enterobacteriaceae than vancomycin-resistant Enterococcus . Despite moderate decolonisation rates in two studies, a reduction in MDRO bloodstream and urinary tract infections was observed. Summary and implications Although a number of smaller cohort studies show some effect of FMT for MDRO decolonisation, questions remain regarding the true efficacy of FMT (taking spontaneous decolonisation into account), the optimal route of administration, the role of antibiotics pre and post-FMT and the efficacy in different patient populations. The observed decrease in MDRO infections post-FMT warrants further research.

Metagenomic, metabolomic, and lipidomic shifts associated with fecal microbiota transplantation for recurrentClostridioides difficileinfection

“…We also noted, alongside other studies 23,24,26 , a significant reduction in antimicrobial resistance genes (AMRs) (Table S5). Members of the Enterobacteriaceae Family dominated the pre-FMT environment and significantly decreased post-FMT, which gave way to members of the Lachnospiraceae Family, and an overall increase in bacterial diversity.…”

“…To date, multiple studies have reported structural changes to the microbiota in rCDI after FMT 14,[22][23][24][25][26] . Specifically, they have observed an increase in the number of commensal bacteria 4 from the Phyla of Firmicutes and Bacteroidetes, and a decrease in Proteobacteria 27 .…”

“…Specifically, they have observed an increase in the number of commensal bacteria 4 from the Phyla of Firmicutes and Bacteroidetes, and a decrease in Proteobacteria 27 . These changes are always accompanied with an increase in alpha diversity 14,[22][23][24][25][26] . While it is not known why an increase in alpha diversity allows for a successful FMT, a recent study found an increase in diversity were able to exclude both Klebsiella pneumoniae and Salmonella enterica serovar Typhimurium from colonizing the gut through the mechanism of nutrient blocking, by consuming nutrients the pathogen needed 28 .…”

Role of the gut microbiota in nutrient competition and protection against intestinal pathogen colonization

“…Faecal microbiota transplant (FMT) has been investigated to treat intestinal colonization with pathogens by reintroducing gut commensals into the intestine that are involved in both direct and indirect mechanisms of colonization resistance. For example, the success of FMT to treat C. difficile is associated with restoration of bile metabolism and SCFA production [100][101][102][103][104][105][106]. FMT has been used successfully to treat recurrent C. difficile infections with a higher success rate than antibiotic treatment [107].…”

“…For example, the success of FMT to treat C. difficile is associated with restoration of bile metabolism and SCFA production [100–106]. FMT has been used successfully to treat recurrent C.…”