Efficacy and Safety of Fecal Microbiota Transplantation for Clearance of Multidrug-Resistant Organisms under Multiple Comorbidities: A Prospective Comparative Trial

Abstract

Fecal microbiota transplantation (FMT) could decolonize multidrug-resistant organisms. We investigated FMT effectiveness and safety in the eradication of carbapenem-resistant Enterobacteriaceae (CRE) and vancomycin-resistant enterococci (VRE) intestinal colonization. A prospective non-randomized comparative study was performed with 48 patients. FMT material (60 g) was obtained from a healthy donor, frozen, and administered via endoscopy. The primary endpoint was 1-month decolonization, and secondary endpoints were 3-month decolonization and adverse events. Microbiota analysis of fecal samples was performed using 16S rRNA sequencing. Intention-to-treat analysis revealed overall negative conversion between the FMT and control groups at 1 (26% vs. 10%, p = 0.264) and 3 (52% vs. 24%, p = 0.049) months. The 1-month and 3-month CRE clearance did not differ significantly by group (36% vs. 10%, p = 0.341; and 71% vs. 30%, p = 0.095, respectively). Among patients with VRE, FMT was ineffective for 1-month or 3-month negative conversion (13% vs. 9%, p > 0.999; and 36% vs. 18%, p = 0.658, respectively) However, cumulative overall negative-conversion rate was significantly higher in the FMT group (p = 0.037). Enterococcus abundance in patients with VRE significantly decreased following FMT. FMT may be effective at decolonizing multidrug-resistant organisms in the intestinal tract.

Modulation of the Gut Microbiota to Control Antimicrobial Resistance (AMR)—A Narrative Review with a Focus on Faecal Microbiota Transplantation (FMT)

“…This is the process of taking donated stool from screened healthy donors and processing it into a treatment administered to recipients for the purpose of improving their health. FMT is now well-established, and guidelines recommend treatment with FMT for patients suffering from recurrent Clostridioides difficile infection (rCDI), in whom the gut microbiota has become extensively disrupted or ‘dysbiotic’ [ 50 , 51 ]. FMT is postulated to work by reversing these perturbations and re-establishing a ‘healthy’ microbiota and metabolome that resists the outgrowth of C. difficile [ 52 ].…”

“…Shin and colleagues undertook a non-randomised controlled trial in multimorbid adult participants colonised with CRE or VRE over a two-year period in Korea [ 51 ]. Treatment allocation to FMT was assigned by participant preference.…”

Role of Probiotics in Preventing Carbapenem-Resistant Enterobacteriaceae Colonization in the Intensive Care Unit: Risk Factors and Microbiome Analysis Study

“…Furthermore, patients with CRE showed low α-diversity, reduced anaerobic bacteria producing short-chain free acids, and increased Enterobacteriaceae [19]. Our previous study showed that patients with CRE exhibited dysbiosis associated with a higher relative abundance of Enterobacteriaceae [5]. Significantly, the reduction in dysbiosis through FMT can decrease the levels of CRE [6], and the effectiveness of FMT in clearing MDRO is influenced by the extent of dysbiosis [4,5].…”

“…Our previous study showed that patients with CRE exhibited dysbiosis associated with a higher relative abundance of Enterobacteriaceae [5]. Significantly, the reduction in dysbiosis through FMT can decrease the levels of CRE [6], and the effectiveness of FMT in clearing MDRO is influenced by the extent of dysbiosis [4,5]. Probiotics may serve as a therapeutic alternative for MDRO colonization by addressing dysbiosis, even in ICU patients [7,20].…”

“…CRE colonization in feces is difficult to treat and can cause severe infections. Notably, fecal microbiota transplantation (FMT) was hypothesized to be a possible treatment option for CRE decolonization [4][5][6]. These previous studies, including our published FMT study, have shown promising results in using FMT for CRE decolonization, with others reporting a successful eradication of CRE from the gastrointestinal tract in a significant proportion of treated patients.…”