Fecal microbiota transplantation to eradicate vancomycin-resistant enterococci colonization in case of an outbreak

Davido, Benjamin; Batista, Rui; Fessi, H.; Michelon, Hugues; Escaut, L.; Lawrence, Christine; Michel, Denis; Perronne, C.; Salomon, Jérôme; Dinh, Aurélien

doi:10.1016/j.medmal.2018.11.002

Cited by 23 publications

(28 citation statements)

References 13 publications

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“…Many factors that influence MDRO eradication might explain this difference, and include host characteristics, microorganisms, or environmental factors. Particularly, antibiotic use after FMT seems to be the main cause of decolonization failure in many cases included in our analysis [40,41,43]. Conversely, the alteration of FMT according to the differences of specific MDRO might be considered to help improve the success rate of treatment.…”

Section: Discussionmentioning

confidence: 91%

“…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: Discussionmentioning

confidence: 91%

Section: Study Selection and Characteristics Of Included Studiesmentioning

confidence: 99%

Section: Outcomes Of Microbiological Eradication In Prospective Studiesmentioning

confidence: 99%

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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“…In other small studies (n = 8 to 20) with various endpoints, the effectiveness of decolonization ranged from 20% to 93% [1,[25][26][27][28][29]. One study by Davido et al suggests that based on an 87% decolonization rate of VRE at three months, FMT should be further explored to combat outbreaks within hospitals [30]. However, because only eight people were in the study, larger studies are needed to determine whether FMT could work in the face of a large outbreak of VRE infection.…”

Section: Fecal Microbiota Transplantationmentioning

confidence: 99%

Bacterial, Gut Microbiome-Modifying Therapies to Defend against Multidrug Resistant Organisms

Feehan

Garcia‐Diaz

2020

Microorganisms

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Antibiotics have revolutionized human and animal healthcare, but their utility is reduced as bacteria evolve resistance mechanisms over time. Thankfully, there are novel antibiotics in the pipeline to overcome resistance, which are mentioned elsewhere in this special issue, but eventually bacteria are expected to evolve resistance to most new compounds as well. Multidrug resistant organisms (MDROs) that cause infections increase morbidity, mortality, and readmissions as compared with susceptible organisms. Consequently, many research and development pipelines are focused on non-antibiotic strategies, including fecal microbiota transplantation (FMT), probiotics and prebiotics, and a range of therapies in between. Studies reviewed here focus on efforts to directly treat or prevent MDRO infections or colonization. The studies were collected through clinicaltrials.gov, PubMed, and the International Conference on the Harmonisation Good Clinical Practice website (ichgcp.net). While the gold standard of clinical research is randomized controlled trials (RCTs), several pilot studies are included because the field is so young. Although a vast preclinical body of research has led to studies in humans, animal and in vitro studies are not within the scope of this review. This narrative review discusses microbiome-modifying therapies targeting MDROs in the gut and includes current results, ongoing clinical trials, companies with therapies in the pipeline specifically for MDROs, and commentary on clinical implementation and challenges.

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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 to eradicate vancomycin-resistant enterococci colonization in case of an outbreak

Cited by 23 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

Bacterial, Gut Microbiome-Modifying Therapies to Defend against Multidrug Resistant Organisms

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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