Fecal microbiota transplantation as a potential way to eradicate multiresistant microorganisms

Dias, Cátia; Pipa, Sara; Duarte-Ribeiro, Filipa; Mota, Margarida

doi:10.1016/j.idcr.2018.e00432

Cited by 6 publications

(4 citation statements)

References 13 publications

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“…Subsequently, 6 articles were excluded after a full-text review. Finally, a total of 20 articles were selected: 10 single cases [25][26][27][28][29][30][31][32][33][34], 3 case series comprising 10 cases [35][36][37], and 7 prospective studies comprising 101 cases [38][39][40][41][42][43][44]. Of these articles, only one was a randomized controlled trial.…”

Section: Study Selection and Characteristics Of Included Studiesmentioning

confidence: 99%

“…Data on 101 patients from 7 articles [37][38][39][40][41][42][43] are shown in Table 2. From the data presented in 5 studies, the median age of included patients was 65 years (IQR, 56 -76 years), and 52.5% of patients were male.…”

Section: Outcomes Of Microbiological Eradication In Prospective Studiesmentioning

confidence: 99%

“…Data on 79 cases from 17 articles [25,[27][28][29][30][31][32][33][34][35][36][37][38][39][41][42][43] were available for outcome analysis by host characteristics and by FMT characteristics. The effect of FMT was better in immunocompromised patients than in immunocompetent patients (Table 3).…”

Section: Outcomes Of Microbiological Eradication By Host Characteristmentioning

confidence: 99%

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Efficacy and safety of fecal microbiota transplantation for decolonization of intestinal multidrug-resistant microorganism carriage: beyond Clostridioides difficile infection

et al. 2019

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Persistent reservoirs of multidrug-resistant microorganisms (MDRO) that are prevalent in hospital settings and communities can lead to the spread of MDRO. Currently, there are no effective decolonization strategies, especially non-pharmacological strategies without antibiotic regimens. Our aim was to evaluate the efficacy and safety of fecal microbiota transplantation (FMT) for the eradication of MDRO. A systematic literature search was performed to identify studies on the use of FMT for the decolonization of MDRO. PubMed, EMBASE, Web of Science, and Cochrane Library were searched from inception through January 2019. Of the 1395 articles identified, 20 studies met the inclusion and exclusion criteria. Overall, the efficacy of FMT for the eradication of each MDRO was 70.3% (102/146) in 121 patients from the 20 articles. The efficacy rates were 68.2% (30/44) for gram-positive bacteria and 70.6% (72/102) for gram-negative bacteria. Minor adverse events, including vomiting, diarrhea, abdominal pain, and ileus, were reported in patients who received FMT. FMT could be a promising strategy to eradicate MDRO in patients. Further studies are needed to confirm these findings and establish a comprehensive FMT protocol for standardized treatment. KEY MESSAGES The development of new antibiotics lags behind the emergence of multidrug-resistant microorganisms (MDRO). New strategies are needed. Theoretically, fecal microbiota transplantation (FMT) might recover the diversity and function of commensal microbiota from dysbiosis in MDRO carriers and help restore colonization resistance to pathogens. A literature review indicated that FMT could be a promising strategy to eradicate MDRO in patients.

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Section: Study Selection and Characteristics Of Included Studiesmentioning

confidence: 99%

Section: Outcomes Of Microbiological Eradication In Prospective Studiesmentioning

confidence: 99%

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Efficacy and safety of fecal microbiota transplantation for decolonization of intestinal multidrug-resistant microorganism carriage: beyond Clostridioides difficile infection

et al. 2019

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“…Fecal microbiota transplants (FMTs) are one method that can restore the colonization resistance that is lost when the community is disrupted. Indeed, numerous published works have shown that FMT is able to restore the healthy and diverse microbial community of the gut and decrease the number of pathogens and antibiotic resistant bacteria in the intestine of both mice and humans [9]–[27]. FMT is a very promising therapy for decolonization and infection prevention, but it will be operationally challenging to use FMT as a prophylactic therapy on all patients who are at risk for infection.…”

Section: Introductionmentioning

confidence: 99%

Microbiome predictors of dysbiosis and VRE decolonization in patients with recurrent <em>C. difficile</em> infections in a multi-center retrospective study

et al. 2019

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The gastrointestinal microbiome is intrinsically linked to the spread of antibiotic resistance. Antibiotic treatment puts patients at risk for colonization by opportunistic pathogens like vancomycin resistant Enterococcus and Clostridioides difficile by destroying the colonization resistance provided by the commensal microbiota. Once colonized, the host is at a much higher risk for infection by that pathogen. Furthermore, we know that microbiome community differences are associated with disease states, but we do not have a good understanding of how we can use these changes to classify different patient populations. To that end, we have performed a multicenter retrospective analysis on patients who received fecal microbiota transplants to treat recurrent Clostridioides difficile infection. We performed 16S rRNA gene sequencing on fecal samples collected as part of this study and used these data to develop a microbiome disruption index. Our microbiome disruption index is a simple index that is predictive across cohorts, indications, and batch effects. We are able to classify pre-fecal transplant vs post-fecal transplant samples in patients with recurrent C. difficile infection, and we are able to predict, using previously-published data from a cohort of patients receiving hematopoietic stem cell transplants, which patients would go on to develop bloodstream infections. Finally, we also identified patients in this cohort that were initially colonized with vancomycin resistant Enterococcus and that 92% (11/12) were decolonized after the transplant, but the microbiome disruption index was unable to predict such decolonization. We, however, were able to compare the relative abundance of different taxa between the two groups, and we found that increased abundance of Enterobacteriaceae predicts whether patients were colonized with vancomycin resistant Enterococcus. This work is an early step towards a better understanding of how microbiome predictors can be used to help improve patient care and patient outcomes.

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The Intestinal Microbiota as a Reservoir and a Therapeutic Target to Fight Multi-Drug-Resistant Bacteria: A Narrative Review of the Literature

et al. 2019

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The appearance and dissemination of antibiotic-resistant bacteria, particularly in specific closed environments such as intensive care units of acute care hospitals, have become a major health concern. The intestinal microbiota has various functions including host protection from overgrowth or colonization by unwanted bacteria. The exposure to antibiotics significantly reduces the bacterial density of intestinal microbiota leaving an ecologic void that can be Enhanced Digital Features To view enhanced digital features for this article go to https://doi.org/10.6084/ m9.figshare.9988634. Key Summary PointsThe human gut acts as a major reservoir of MDR bacteria, where they overgrow and share genetic determinants of resistance with other species, perpetuating their spread.The most common strategy for gut decolonization is the use of oral, nonabsorbable antibiotics, although fecal microbiota transference (FMT) is a promising intervention.We summarize 145 FMTs performed for intestinal decolonization of MDR bacteria in the last 5 years from 25 publications.According to our analysis, FMT was significantly more successful against GPC than GNB, with no antibiotic consumption after FMT in the case of concomitant CDI and in older versus recent reports.

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Fecal microbiota transplantation as a potential way to eradicate multiresistant microorganisms

Cited by 6 publications

References 13 publications

Efficacy and safety of fecal microbiota transplantation for decolonization of intestinal multidrug-resistant microorganism carriage: beyond Clostridioides difficile infection

Efficacy and safety of fecal microbiota transplantation for decolonization of intestinal multidrug-resistant microorganism carriage: beyond Clostridioides difficile infection

Microbiome predictors of dysbiosis and VRE decolonization in patients with recurrent <em>C. difficile</em> infections in a multi-center retrospective study

The Intestinal Microbiota as a Reservoir and a Therapeutic Target to Fight Multi-Drug-Resistant Bacteria: A Narrative Review of the Literature

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