Is there a role of faecal microbiota transplantation in reducing antibiotic resistance burden in gut? A systematic review and Meta-analysis

Abstract

Objectives The aim of current systematic review and meta-analysis is to provide insight into the therapeutic efficacy of fecal microbiota transplantation (FMT) for the decolonization of antimicrobial-resistant (AMR) bacteria from the gut. Methods The protocol for this Systematic Review was prospectively registered with PROSPERO (CRD42020203634). Four databases (EMBASE, MEDLINE, SCOPUS, and WEB of SCIENCE) were consulted up until September 2020. A total of fourteen studies [ in vivo ( n = 2), case reports ( n = 7), case series without control arm ( n = 3), randomized clinical trials (RCT, n = 2)], were reviewed. Data were synthesized narratively for the case reports, along with a proportion meta-analysis for the case series studies ( n = 102 subjects) without a control arm followed by another meta-analysis for case series studies with a defined control arm ( n = 111 subjects) for their primary outcomes. Results Overall, seven non-duplicate case reports ( n = 9 participants) were narratively reviewed and found to have broad AMR remission events at the 1-month time point. Proportion meta-analysis of case series studies showed an overall 0.58 (95% CI: 0.42-0.74) AMR remission. Additionally, a significant difference in AMR remission was observed in FMT vs treatment naïve (RR = 0.44; 95% CI: 0.20-0.99) and moderate heterogeneity ( I 2 =65%). A subgroup analysis of RCTs ( n = 2) revealed FMT with further benefits of AMR remission with low statistical heterogeneity (RR = 0.37; 95% CI: 0.18-0.79; I 2 =23%). Conclusion More rigorous RCTs with larger sample size and standardized protocols on FMTs for gut decolonization of AMR organisms are warranted. KEY MESSAGE Existing studies in this subject are limited and of low quality with moderate heterogeneity, and do not allow definitive conclusions to be drawn. More rigorous RCTs with larger sample size and standardized protocols on FMTs for gut decolonization of AMR organisms are warranted.

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

“…All study settings (community, outpatient and inpatient) were allowed. We excluded studies published before 2020, since a recent meta-analysis has been performed with studies published before 2020 [ 18 ]. Finally, we excluded murine (or other animal) studies, reviews and meta-analyses.…”

“…Contrary to rCDI, less is known about the degree of dysbiosis in individuals with MDRO colonisation, though some studies report decreased species richness in this population as well [ 13 , 14 ]. Several small studies, including one randomised controlled trial (RCT) [ 15 ▪▪ ], have explored whether FMT is an effective modality to decolonise patients with MDRO, as summarised by several recent reviews [ 16 – 18 ]. These reviews conclude that FMT is a promising treatment strategy for MDRO decolonisation, although the RCT by Huttner et al [ 15 ▪▪ ] did not find a significant difference, but was terminated early.…”

“…The objective of this review is to provide an update on how the field of FMT for MDRO decolonisation has developed during the past year, by highlighting recently published and ongoing studies, ultimately to assess whether FMT is an effective treatment strategy for intestinal MDRO decolonisation. Adding to the recent overview provided by Dharmaratne et al [ 18 ], this review includes several newer studies, as well as studies with paediatric patients.…”

Fecal Microbiota Transplantation and Health Outcomes: An Umbrella Review of Meta-Analyses of Randomized Controlled Trials

“…Considering the purpose of the present umbrella review, we selected those studies that included the largest number of RCTs. Ultimately, 7 meta-analyses met the eligibility criteria ( Hui et al., 2019 ; Ianiro et al., 2019 ; Caldeira et al., 2020 ; Proença et al., 2020 ; Tang et al., 2020 ; Dharmaratne et al., 2021 ; Fang et al., 2021 ). Figure 2 shows the flowchart of the literature search.…”

Progress in Alternative Strategies to Combat Antimicrobial Resistance: Focus on Antibiotics

“…Through the administration of fresh, frozen, or encapsulated fecal matter from a suitable donor, the unhealthy gut microbiota of the patient is restored, re-establishing the alpha-diversity. Treatment with FMT is especially recommended for recurrent Clostridium difficile infections, showing over a 90% of efficacy in randomized clinical trials [ 351 ]. FMT is also efficient in displacing vancomycin-resistant Enterococcus when they are predominant over the rest of gut microbiota and also when C. difficile is present [ 352 ].…”