Fecal Microbial Transplants Reduce Antibiotic-resistant Genes in Patients With Recurrent<i>Clostridium difficile</i>Infection

Millan, Braden; Park, Heekuk; Hotte, Naomi; Mathieu, Olivier; Burguière, Pierre; Tompkins, Thomas A.; Kao, Dina; Madsen, Karen

doi:10.1093/cid/ciw185

Cited by 185 publications

(173 citation statements)

References 31 publications

Supporting

Mentioning

163

Contrasting

Unclassified

Order By: Relevance

“…The rate of partial ARB decolonization was even higher, at 80%. The reported results are in line with recent observations by Millan et al who reported that FMT used to treat recurrent C. difficile infection reduces the load of antibiotic-resistant genes in the gut of patients heavily pretreated with antibiotics [34].…”

Section: Discussionsupporting

confidence: 92%

Fecal Microbiota Transplantation in Patients With Blood Disorders Inhibits Gut Colonization With Antibiotic-Resistant Bacteria: Results of a Prospective, Single-Center Study

Biliński

Grzesiowski²,

Sørensen

et al. 2017

Clinical Infectious Diseases

230

176

View full text Add to dashboard Cite

Background.Patients with blood disorders colonized with antibiotic-resistant bacteria (ARB) are prone to systemic infections that are difficult to treat. Reintroduction of commensal bacteria in a murine model of enterococcal colonization of the gut can lead to eradication of enterococci. We hypothesized that fecal microbiota transplantation (FMT) could be used to eradicate ARB in humans.Methods. Participants colonized with ARB were treated with intraduodenal FMT according to a prospective protocol (NCT02461199). The primary endpoint was complete ARB decolonization at 1 month after FMT. Secondary endpoints included safety assessment and partial ARB decolonization. Microbiome sequencing was performed to investigate the influence of microbial composition of the transplanted material on the outcome of FMT.Results. Twenty-five FMTs were performed in 20 participants (including 40% who had neutropenia) who were colonized by a median of 2 (range, 1-4) strains of ARB. The primary endpoint was reached in 15/25 (60%) of the FMTs and more frequently in cases in which there was no periprocedural use of antibiotics (79% vs 36%, P < .05). Among participants, 15/20 (75%) experienced complete ARB decolonization. There were no severe adverse events, and partial ARB decolonization was observed in 20/25 (80%) of the FMTs. The microbiota composition analysis revealed higher abundance of Barnesiella spp., Bacteroides, and Butyricimonas and greater bacterial richness in the fecal material, resulting in eradication of Klebsiella pneumoniae compared with nonresponders.Conclusions. FMT in patients with blood disorders is safe and promotes eradication of ARB from the gastrointestinal tract. Clinical Trials Registration. NCT02461199.

show abstract

Section: Discussionsupporting

confidence: 92%

Fecal Microbiota Transplantation in Patients With Blood Disorders Inhibits Gut Colonization With Antibiotic-Resistant Bacteria: Results of a Prospective, Single-Center Study

Biliński

Grzesiowski²,

Sørensen

et al. 2017

Clinical Infectious Diseases

230

176

View full text Add to dashboard Cite

show abstract

“…In a recent study of the effects of FMT on the resistome, FMT was associated with a reduction in the number of different categories of resistance as well as the number of individual determinants [23]. This contraction in the resistome was associated with an increase in the genus- and species-level diversity of the microbiota overall and a decrease in enterobacteriaceae, reflecting what is likely an increased concentration of antibiotic resistance determinants in this family of organisms.…”

Section: Antibiotic Effects On the Microbiomementioning

confidence: 99%

Effects of short- and long-course antibiotics on the lower intestinal microbiome as they relate to traveller’s diarrhea

McDonald

2017

Journal of Travel Medicine

View full text Add to dashboard Cite

Background Antibiotics have profound and lasting effects on the lower intestinal (gut) microbiome that can both promote resistance and increase susceptibility to colonization and infection; knowledge of these changes is important to the prevention and treatment of traveler’s diarrhea. Methods Recent data from epidemiologic and modern metagenomics studies were reviewed in regard to how such findings could inform the prevention and treatment of traveler’s diarrhea. Results Although it is well recognized that antibiotics increase the risk for Clostridium difficile infection, it is less recognized how they predispose patients to typically foodborne pathogens such as Salmonella or Camplyobacter spp. While these pathogens account for only a fraction of traveler’s diarrhea, such predisposition reflects how antibiotic exposure that precedes or occurs during travel may increase the risk for infection with other more common pathogens, even possibly enterotoxigenic Eschericia coli, especially in the setting of acquired resistance. Even short antibiotic exposures disrupt the gut microbiome up to a year or more and repeated exposures appear to attenuate recovery from ever occurring. One bacterial phylum that commonly increases in the gut following antibiotics are the proteobacteria including Enterobacteriacea; these are pro-inflammatory and often carry antibiotic resistance genes, the number and diversity of these genes (i.e. the resistome) commonly expands following antibiotics. The gut resistome among healthy community-dwelling adults reflects geographic variability in antibiotic use practices in both humans and food-producing animals as well as possibly the transmission of antibiotic resistance genes through the food supply. Conclusions Because antibiotic use among travelers will influence the resistome and thereby promote geographic spread of resistance, it is important that antibiotic use recommendations for travelers be guided by resistance surveillance data as well as a careful assessment of the risks and benefits to both the individual and society.

show abstract

“…43,44 Case reports and case series have shown that FMT can effectively reduce the overall number of antibiotic resistance genes as well as eradicate colonic colonization by MDRO. 45,46 Some have advocated for a whole genome sequencing approach to screening for antibiotic resistance while others have indicated that the field is changing too rapidly to establish actionable/understandable platforms and that this approach is much more costly. 47,48 One of the most attractive features of FMT for CDI is that it is a non-antibiotic based approach to treatment of an antibiotic-associated illness.…”

Section: Antibiotic Resistance Screening and The Resistomementioning

confidence: 99%

Challenges in fecal donor selection and screening for fecal microbiota transplantation: A review

et al. 2017

View full text Add to dashboard Cite

Fecal microbiota transplantation is best understood as an effective and inexpensive therapy for recurrent Clostridium difficile infection but fecal donor selection and screening should be periodically revised. Here, we review current recommendations for selection and screening of fecal donors for fecal microbiota transplantation. We recommend considering diabetes mellitus, prior cardiovascular events, and clinical healthcare exposure as fecal donor exclusion criteria until more is known about the association of these conditions with the human gut microbiome. We review the non-bacterial members of the human gut microbiome, associations of the gut microbiome with colorectal malignancies, the human gut resistome and how these may impact future donor screening recommendations. Collaboration between clinicians, clinical laboratory scientists, industry and regulatory agencies will be critically important for continued improvement in donor selection and screening.

show abstract

Fecal Microbial Transplants Reduce Antibiotic-resistant Genes in Patients With RecurrentClostridium difficileInfection

Cited by 185 publications

References 31 publications

Fecal Microbiota Transplantation in Patients With Blood Disorders Inhibits Gut Colonization With Antibiotic-Resistant Bacteria: Results of a Prospective, Single-Center Study

Fecal Microbiota Transplantation in Patients With Blood Disorders Inhibits Gut Colonization With Antibiotic-Resistant Bacteria: Results of a Prospective, Single-Center Study

Effects of short- and long-course antibiotics on the lower intestinal microbiome as they relate to traveller’s diarrhea

Challenges in fecal donor selection and screening for fecal microbiota transplantation: A review

Contact Info

Product

Resources

About