FMT may be beneficial in patients with multidrug-resistant organisms
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Patients with multidrug-resistant organisms treated with fecal microbiota transplantation had shorter hospitalizations, fewer infections in their bloodstream and had easier-to-treat infections, according to an expert presenting data during a press conference in advance of Digestive Disease Week data publication.
Julian Marchesi, PhD, professor of human microbiome research at Cardiff University and professor of digestive health at Imperial College London, presented that data on behalf of his team in a media briefing.
“[We] wanted to explore whether FMT could decolonize multidrug-resistant bacteria that have developed resistance to more than one antibiotic from the gut microbiota, so they were untreatable with current antibiotics,” he said. “We also wanted to know if FMT could also impact other clinical outcomes, such as length of hospital stay, readmissions and development of bloodstream infections.”
In their study, researchers looked at 20 patients with MDROs who received a single upper gastrointestinal FMT. Of that group, 11 had chronic hematological disease, and nine had recurrent extended spectrum beta-lactamase urinary tract infections (ESBL UTIs). They followed patients for 6 months after transplantation and researchers compared their clinical course with the 6 months prior to FMT.
Marchesi and colleagues found that the MDROs cleared in only seven of 17 patients at 6 months of follow-up. However, they reported improvements in four key clinical domains, including a reduction in MDRO bloodstream infection (P = .047), reduction in all bloodstream infections (P = .03), shorter length of stay in hospital (P = .0002) and fewer number of days of carbapenem use (P = .0005).
Marchesi said it is not completely clear what the mechanism of action is for the benefit of FMT on MDRO outcomes, but said it could be one of three mechanisms; improving gut barrier function, introducing organisms that compete with the MDROs, or the transfer of viruses that might be attacking the bacteria.
“This suggests FMT is safe to use in high-risk patients with bloodstream infections, both immunocompromised or immunosuppressed,” Marchesi said. “They also show the benefit of FMT might not only be from decolonizing the patient from the resistant organism, but there could be positive impacts on other microbiome-related mechanisms that need to be studied further.”
Marchesi added that researchers were moving toward starting a larger trial before being delayed by the COVID-19 pandemic.
Reference:
Mullish, et al. Abstract 626. Presented at: Digestive Disease Week; May 2-5, 2020 (meeting canceled).
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