Mechanistic Insights in the Success of Fecal Microbiota Transplants for the Treatment of Clostridium difficile Infections

Baktash, Amoe; Terveer, Elisabeth M.; Zwittink, Romy D.; Hornung, Bastian; Corver, Jeroen; Kuijper, Ed J.; Smits, Wiep Klaas

doi:10.3389/fmicb.2018.01242

Cited by 77 publications

(73 citation statements)

References 187 publications

(272 reference statements)

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“…polymorphum (BCRC no: 17679 Hsinchu, Taiwan) and A. actinomycetemcomitans (BCRC no: 14405 Hsinchu, Taiwan) were purchased from the BCRC, Hsinchu City, Taiwan. S. mutans was cultured in tryptic soy broth (TSB; BD) (Baktash et al ), P. gingivalis and F. nucleatum subsp . polymorphum were cultured in TSB supplemented with 5% sheep’s blood and A. actinomycetemcomitans was cultured in brain–heart infusion (BHI) broth (BD).…”

Section: Methodsmentioning

confidence: 99%

Antibacterial activity of viable and heat‐killed probiotic strains against oral pathogens

Chen

Hsieh

et al. 2020

Lett Appl Microbiol

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Probiotics can stabilize gut flora, regulate intestinal immunity and protect the host from enteric diseases; however, their roles in oral health have received little attention compared to their roles in gut health. Nowadays, the prevalence of sugar‐sweetened foods and abuse of antibiotics contribute towards dysbiosis of oral microbiota and drug resistance development in oral pathogens, resulting in various intractable oral diseases. We screened the antibacterial activities of viable and heat‐killed probiotic strains against the oral pathogens Streptococcus mutans, Porphyromonas gingivalis, Fusobacterium nucleatum and Aggregatibacter actinomycetemcomitans. The probiotic strains Lactobacillus salivarius subsp. salicinius AP‐32, L. rhamnosus CT‐53, L. paracasei ET‐66 and Bifidobacterium animalis subsp. lactis CP‐9 displayed strong antipathogenic activities, whereas heat‐killed AP‐32, CT‐53 and ET‐66 displayed high levels of pathogen inhibition. The antibacterial activities of these probiotics were not associated with their H2O2 production; L. acidophilus TYCA02 produced high levels of H2O2 but merely exhibited moderate antibacterial activities. Oral tablets containing probiotics showed positive inhibitory effects against oral pathogens, particularly those containing viable probiotics. Our results indicate that probiotics prevent the growth of oral pathogens and improve oral health, providing insights into the antipathogenic efficacy of different probiotic species and their potential role in functional foods that improve oral health. Significance and Impact of the Study Our study provides insights into the antipathogenic efficacy of different probiotic species and their potential roles in developing functional foods to improve oral health. We showed that the probiotic strains Lactobacillus salivarius subsp. salicinius AP‐32, L. rhamnosus CT‐53, L. paracasei ET‐66 and Bifidobacterium animalis subsp. lactis CP‐9 have great potential for use in the development of functional foods to improve oral health. Since active probiotics may provide strong and long‐term protection, the development of functional food products should favour the use of viable bacteria.

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Section: Methodsmentioning

confidence: 99%

Antibacterial activity of viable and heat‐killed probiotic strains against oral pathogens

Chen

Hsieh

et al. 2020

Lett Appl Microbiol

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“…Fidaxomicin has recently also been approved for CDI treatment, but its use is limited by high costs 12 . Fecal microbiota transplantation (FMT) is effective at treating recurrent CDI (rCDI) that is refractory to antimicrobial therapy 17 . Reduced susceptibility and resistance to clinically used antimicrobials, including metronidazole, has been reported and this, combined with the intrinsic multiple drug-resistant nature of C. difficile, stresses the importance for the development of better diagnostics and new effective treatment modalities 8 .…”

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confidence: 99%

Plasmid-mediated metronidazole resistance in Clostridioides difficile

et al. 2020

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Metronidazole was until recently used as a first-line treatment for potentially life-threatening Clostridioides difficile (CD) infection. Although cases of metronidazole resistance have been documented, no clear mechanism for metronidazole resistance or a role for plasmids in antimicrobial resistance has been described for CD. Here, we report genome sequences of seven susceptible and sixteen resistant CD isolates from human and animal sources, including isolates from a patient with recurrent CD infection by a PCR ribotype (RT) 020 strain, which developed resistance to metronidazole over the course of treatment (minimal inhibitory concentration [MIC] = 8 mg L −1). Metronidazole resistance correlates with the presence of a 7-kb plasmid, pCD-METRO. pCD-METRO is present in toxigenic and non-toxigenic resistant (n = 23), but not susceptible (n = 563), isolates from multiple countries. Introduction of a pCD-METRO-derived vector into a susceptible strain increases the MIC 25-fold. Our finding of plasmid-mediated resistance can impact diagnostics and treatment of CD infections.

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“…A faecal microbiota transplant (FMT) is indicated when a patient has failed the appropriate antibiotic treatment or experienced two episodes of recurrence, as FMT has the highest rate of prevention for recurrent CDI among all treatment options 8 9. FMTs are considered a novel approach that reconstitutes a diverse gut microbiome through multifactorial mechanisms 10–12. In patients with complications such as megacolon, colonic perforation, acute abdomen or septic shock associated with organ failure, surgical intervention is recommended 8…”

Section: Introductionmentioning

confidence: 99%

Management of difficult-to-treatClostridioides difficilein a patient with chronic osteomyelitis

2020

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A 61-year-old male patient being treated with intravenous antibiotics for left foot osteomyelitis presented to the hospital septic, with several days of worsening abdominal pain, bloating and watery bowel movements. Investigation revealed that the patient had severe, treatment-resistant Clostridioides difficile colitis. He was initially treated with oral vancomycin and intravenous metronidazole, which was switched to oral fidaxomicin. After no improvement in the patient’s symptoms, he was treated with two faecal microbiota transplants. He was offered a third faecal microbiota transplant but declined. The patient was placed back on oral fidaxomicin and saw ultimate resolution of his symptoms. This case provides an example of a treatment pathway for refractory C. difficile infection.

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Mechanistic Insights in the Success of Fecal Microbiota Transplants for the Treatment of Clostridium difficile Infections

Cited by 77 publications

References 187 publications

Antibacterial activity of viable and heat‐killed probiotic strains against oral pathogens

Antibacterial activity of viable and heat‐killed probiotic strains against oral pathogens

Plasmid-mediated metronidazole resistance in Clostridioides difficile

Management of difficult-to-treatClostridioides difficilein a patient with chronic osteomyelitis

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