Fecal Microbiota Transplantation as an Effective Treatment for Carbapenem-Resistant Klebsiella pneumoniae Infection in a Renal Transplant Patient

Abstract

Background: In renal transplant recipients, carbapenem-resistant Klebsiella pneumoniae (CRKP) infection is a common complication, and usually associated with severe clinical outcomes due to a lack of effective treatment. Case Presentation: A 37-year-old woman with CRKP infection one month after kidney transplantation was involved in this study. Microbial characteristics of fecal samples from the patient were analyzed. Fecal microbiota transplantation (FMT) was performed for treating the CRKP infection. One week after FMT, the patient's urine and anal swab cultures returned negative for CRKP, and 17 days after FMT, the incision showed complete healing. Moreover, the patient had no symptoms of infection two months after FMT. Alpha diversity analyses showed that before FMT, the patient was associated with obviously lower species richness and diversity than the donor, which significantly increased at one week, three weeks and two months after FMT. Beta diversity analyses showed that though the patient's microbial community post-FMT still differed from the donor composition, their distances decreased visibly, especially at one week and three weeks after FMT. Obvious shift in microbial composition could be observed before and after FMT. The microbial composition of the patient post FMT resembled the donor composition. Relative abundance of genera such as Phascolarctobacterium and Lachnoclostridium increased after FMT, while the relative abundance of Klebsiella significantly decreased. Conclusion:This study demonstrated the therapeutic effect of FMT on infections caused by CRKP for a renal transplant patient. Further studies are required to confirm the findings of this study.

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

“…investigating post-FMT faecal composition or decolonisation of extra-intestinal sites instead. Finally, a total of 36 studies were included: seven cohort studies [ 22 , 23 ▪ , 24 ▪ , 25 ▪▪ , 26 – 28 ], five case reports [ 29 – 33 ], and 24 ongoing trials.…”

“…A total of 254 patients were assessed in the included cohort studies and case reports, with only one study investigating paediatric patients [ 27 ]. Eight studies included immunocompromised patients, mostly undergoing allo-SCT [ 23 ▪ , 24 ▪ , 27 , 29 – 33 ], and three studies included a total of 14 patients with concurrent rCDI [ 24 ▪ , 26 , 28 ]. Although most studies required one positive stool culture or rectal/perianal swab for the definition of colonisation, decolonisation was often confirmed by serial cultures or swabs.…”

“…Ghani et al [ 24 ▪ ] did not specify the type of MDRO for their control group. To the best of our knowledge, the study by Wang et al [ 33 ] is the first study investigating the efficacy of FMT for gut eradication of a hypervirulent K. pneumoniae strain.…”

“…Whereas stool volume varied (from 25 to 100 g), all stool samples were obtained from healthy, unrelated donors, and were mostly frozen. One study [ 27 ] pretreated patients with nonabsorbable antibiotics (oral colistin), and in seven studies patients had used antibiotics in the week prior to FMT [ 24 ▪ , 25 ▪▪ , 26 , 28 , 29 , 31 , 33 ]. Patients were pretreated with PPI in seven studies, and bowel lavage in six studies.…”

“…Recolonisation also occurred during antibiotic prophylaxis (for allo-SCT) in an adult patient. [ 30 ] Silva et al [ 28 ], Su et al [ 32 ] and Wang et al [ 33 ] were the only studies in which patients did not receive antibiotics after FMT. Prolonged decolonisation was achieved in four out of five CRE patients in the first study, and in both patients in the case reports.…”