Intestinal dysbiosis in carbapenem-resistant Enterobacteriaceae carriers

Abstract

<jats:title>Abstract</jats:title><jats:p>Infection with Carbapenem-Resistant Enterobacteriaceae (CRE) became an important challenge in health-care settings and a growing concern worldwide. Since infection is preceded by colonization, an understanding of the latter may reduce CRE-infections. We aimed to characterize the gut microbiota after colonization by CRE, assuming that an imbalanced gastrointestinal tract (GIT)-associated microbiota precedes CRE-colonization.</jats:p><jats:p>We evaluated the GIT-microbiota using 16S rRNA genes sequencing extracted of fecal samples, collected from hospitalized CRE-carriers, and two control groups of hospitalized non-carriers and healthy adults. The microbiota diversity and composition in CRE-colonized patients differed from that of the control groups participants. These CRE-carriers displayed lower phylogenetic diversity and dysbiotic microbiota, enriched with members of the Enterobacteriaceae family. Concurrent with the bloom in Enterobacteriaceae, a depletion of anaerobic commensals was observed. Additionally, changes in several predicted metabolic pathways were observed for the CRE-carriers. Concomitant, we found higher prevalence of bacteremia in the CRE-carriers.</jats:p><jats:p>Several clinical factors that might induce change in the microbiota were examined and found as insignificant between the groups.</jats:p><jats:p>CRE-colonized patients have dysbiotic gut microbiota in terms of diversity and community membership, associated with increased risk for systemic infection. Our study results provides justification for attempts to restore the dysbiotic microbiota with probiotics or fecal transplantation.</jats:p>

Colonization With Multidrug-Resistant Organisms Among Healthy Adults in the Community Setting: Prevalence, Risk Factors, and Composition of Gut Microbiome

“…To date, only two studies in rural areas have investigated the composition of gut microbiota in participants with or without colonization by ESBL-producing Enterobacteriaceae ( Gosalbes et al, 2015 ; Piewngam et al, 2019 ), and both studies included fewer cases than did our study. We showed that the gut microbiota of 3GC-R Enterobacteriaceae carriers was characterized by an increased relative abundance of Proteobacteria and Enterobacteriaceae ; similar results had been described in CRE-carriers ( Korach-Rechtman et al, 2019 ). The expansion of Enterobacteriaceae in gut microbiota is regarded as a signature of dysbiosis, which could be induced by intestinal inflammation or treatment with antibiotics ( Shin et al, 2015 ; Litvak et al, 2017 ).…”

Emerging superbugs: The threat of Carbapenem Resistant Enterobacteriaceae

“…In line with these observations, it is reasonable to assume that restoration of normal gut microbiota may contribute to the eradication of CRE carriage. Indeed, several studies have found relationship between dysbiosis and the spread of CRE as demonstrated by a recent study linking intestinal dysbiosis with intestinal colonization with CRE and ultimately a higher prevalence of bacteremia in hospitalized patients [18] , a phenomenon that is particularly frequent in LTACH [13] .…”

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

“…In these patients, FMT increases microbiota diversity, while decreasing the number of antibiotic resistance genes [11,12]. 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][17][18].…”