FMT safe, effective for eradicating antibiotic-resistant bacteria in patients with blood disorders

Fecal microbiota transplantation was safe for patients with blood disorders and inhibited gut colonization by antibiotic-resistant bacteria, according to results from a prospective study.

“Recent studies have revealed that the commensal microbiota in the human gut act as a large reservoir of antibiotic-resistance genes. Colonized patients pose an epidemiological threat to other hospitalized individuals or to members of their households but are also in danger of developing systemic infections with gut-colonizing microorganisms,” Jaroslaw Bilinski, MD, of the department of hematology, oncology and internal diseases at the Medical University of Warsaw, Poland, and colleagues wrote. “This is especially the case for patients with blood disorders due to the suppression of their innate and/or acquired immunity.”

The researchers performed 25 intraduodenal fecal microbiota transplantations on 20 patients with antibiotic-resistant bacteria colonization. The primary endpoint was complete antibiotic-resistant decolonization at 1 month after transplantation, and secondary endpoints were safety of transplantation and partial decolonization. Bilinski and colleagues performed microbiome sequencing to investigate how the microbial composition of the transplant influenced the outcome of the procedure.

Nearly half (40%) of patients had neutropenia. Patients were colonized by a median of 2 strains of antibiotic-resistant bacteria (range, 1-4). The researchers wrote that most procedures (60%; n = 15 of 25) achieved complete decolonization at 1 month. Decolonization occurred more often in procedures where the patient had not received periprocedural antibiotics (79% vs. 36%; P < .05). Overall, 75% of patients (n = 15) achieved complete decolonization, Bilinski and colleagues wrote. The researchers reported no adverse events. Responders had a greater abundance of Barnesiella, Bacteroides and Butyricimonas in their fecal matter compared with nonresponders, resulting in eradication of Klebsiella pneumoniae, the microbiota analysis found.

“In conclusion, our study clearly showed that fecal microbiota transplantation is a safe procedure for patients with blood disorders,” Bilinski and colleagues wrote. “Fecal microbiota transplantation promoted decolonization of most participants, although administration of antibiotics shortly after transplantation decreased the success rate. Fecal microbiota transplantation appears to constitute a valid tool to tackle colonization of the gut by antibiotic-resistant bacteria in patients with blood disorders.” – by Andy Polhamus

Disclosure: Bilinski reports no relevant financial disclosures. Please see the full study for a complete list of all other researchers’ relevant financial disclosures.