The following article is part of coverage from Digestive Disease Week (DDW 2020). Due to the global COVID-19 pandemic, the American Gastroenterology Association made the necessary decision to cancel the meeting originally scheduled for May 2–May 5, 2020, in Chicago. While live events will not proceed as planned, readers can click here catch up on the latest research intended to be presented at the meeting.
Fecal microbiota transplant (FMT) appears safe in decolonizing multi-drug resistant organisms (MDRO) from intestinal reservoirs in affected patients, even those who are highly immunosuppressed. Though FMT treatment resulted in only reasonable levels of decolonization, it was also associated with other clinical benefits including decreased length of stay, episodes of invasive infection, and requirement for antibiotic therapy, according to results intended to be presented at Digestive Disease Week (DDW) 2020.
Researchers conducted FMT in 17 patients with intestinal colonization of MDROs. All MDROs were identified through rectal screen and identified as carbapenemase-producing Enterobacteriaceae, vancomycin-resistant Enterococci, or extended-spectrum β-lactamase (ESBL) Enterobacteriaceae. Patients were followed 6 months before and after FMT procedure.
A minority of patients (41%; n=7) achieved intestinal decolonization at 6 months after FMT. No adverse effects were reported.
For the 9 patients who had recurrent ESBL urinary tract infections (UTIs) prior to FMT, episodes of ESBL UTIs decreased from 4±2 episodes (median ± standard deviation) before FMT to 1±2 episodes post-FMT (P =.008).
A total of 11 patients had chronic hematologic disease, and 8 of those individuals had undergone stem cell transplants within 6 months of FMT. These patients experienced a decrease in inpatient stay duration (P =.002). The trend of decreased hospital stays was observed in all but 1 of the patients (P =.0002).
The study participants had fewer days using carbapenems (P =.0005), bloodstream infections by both Enterobacteriaceae and Enterococci (P =.047), and total number of bloodstream infections (P =.028) in the 6 months after transplant procedure.
Limitations of this study included its small sample size and short duration. Likewise, it remains unclear what the long-term impact of its findings on patient health is.
The investigators concluded that although a minority of study participants had MDRO decolonization, FMT was associated clinical benefit, including reduction in infections requiring antibiotic treatment and length of hospitalization stays.
The researchers note that further studies are needed to identify other microbiota-mediated mechanisms beyond decolonization that may be responsible for the observed clinical benefits in patients with intestinal MDROs.
Disclosures: Some authors declared receiving consulting or funding from the pharmaceutical industry. A complete list of disclosures can be found in the original study.
Ghani R, Mullish B H, McDonald J A, et al. Fecal microbiota transplant for multi-drug resistant organisms: improved clinical outcomes beyond intestinal decolinisation. Abstract intended to be presented at Digestive Disease Week 2020; May 2020 (canceled). Chicago, Illinois, United States of America.