The use of fecal microbiota transplantation is an option to eradicate highly drug-resistant enteric bacteria carriage, according to results from a small pilot study conducted by French investigators.
“A rapid and dramatic emergence of highly drug-resistant enteric bacteria (HDREB), i.e., carbapenem-resistant Enterobacteriaceae (CRE) and vancomycin-resistant enterococci (VRE), is occurring worldwide,” researchers led by Benjamin Davido, MD, of the infectious diseases unit at Raymond Poincaré Teaching Hospital, Garches, France, wrote in a study published online Feb. 1 in the Journal of Hospital Infection. “Patients carrying these bacteria are at risk of developing severe infections due to these bacteria; these infections are associated with a high mortality rate, partially because of inappropriate antimicrobial treatment.”
copyright CDC/James Archer
Citing recent studies that have demonstrated the efficacy of fecal microbiota transplant (FMT) as an accepted therapy to prevent recurrent Clostridium difficile infection, Dr. Davido and his associates prospectively identified eight different case reports of FMT used in adults for intestinal decolonization from extended-spectrum beta-lactamase (ESBL)–producing Enterobacteriaceae, VRE, or methicillin-resistant Staphylococcus aureus. Patients on immunosuppressive agents were excluded from the study, as were those taking antibiotics at the time of FMT (J Hosp Infect. 2017 Feb. 1. doi: 10.1016/j.jhin.2017.02.001).
The protocol for the procedure involved insertion of a nasoduodenal tube the day before FMT in order to perform a bowel lavage with XPrep solution. FMT was performed using a frozen preparation of fecal microbiota from a universal donor who was previously screened for potential diseases. The main outcome of interest was time to successful decolonization following FMT, which was determined by at least two consecutive negative rectal swabs at a 1-week interval during a follow-up of 3 months.
The mean age of the eight patients was 70 years, their median Charlson comorbidity index score was 5, and the median duration of carriage of HDREB before FMT was 83 days. The researchers observed that 1 month after FMT, two patients were free from CRE colonization, while one more patient was free from VRE after 3 months. Five patients received antibiotic during follow-up. Among them, one patient was decolonized at 1 month, while another was decolonized at 3 months. One patient with cirrhosis and persistent VRE carriage died 3 months after FMT from ascetic fluid infection and VRE bacteremia. No other adverse events were reported.
“In a context where no other efficient strategy is available, our first results show that FMT seems to be safe, with an impact on CRE decolonization at 1 month and on VRE decolonization at 3 months,” the researchers concluded. “Of particular importance, there was no recolonization after the intervention, which is contrary to decolonization with antibiotics. However, our study has important limitations in that the sample size was very small, it was nonrandomized, and follow-up was limited to a 3-month period.” They noted that at least five trials are underway to investigate the impact of FMT on multidrug resistant organism bacterial decolonization. The researchers reported having no financial disclosures.