Infectious Diseases Unit, Raymond Poincaré Teaching Hospital, APHP, Versailles Saint-Quentin University, Garches, France.
Nephrology Unit, Tenon Teaching Hospital, APHP, Pierre et Marie Curie University, Paris, France.
J Hosp Infect. 2018 Aug;99(4):481-486. doi: 10.1016/j.jhin.2018.02.018. Epub 2018 Mar 2.
Carbapenem-resistant Enterobacteriaceae (CRE) and vancomycin-resistant enterococci (VRE) carriage are increasing worldwide. Faecal microbiota transplantation (FMT) appears to be an attractive option for decolonization. This study aimed to evaluate CRE vs VRE clearance by FMT among carriers.
A multi-centre trial was undertaken on patients with CRE or VRE digestive tract colonization who received FMT between January 2015 and April 2017. Adult patients with CRE or VRE colonization, confirmed by three consecutive rectal swabs at weekly intervals, including one in the week prior to FMT, were included in the study. Patients with immunosuppression or concomitant antibiotic prescription at the time of FMT were excluded. Successful decolonization was determined by at least two consecutive negative rectal swabs [polymerase chain reaction (PCR) and culture] on Days 7, 14, 21 and 28, and monthly for three months following FMT.
Seventeen patients were included, with a median age of 73 years [interquartile range (IQR) 64.3-79.0]. Median duration of carriage of CRE or VRE before FMT was 62.5 days (IQR 57.0-77.5). One week after FMT, three of eight patients were free of CRE colonization and three of nine patients were free of VRE colonization. After three months, four of eight patients were free of CRE colonization and seven of eight patients were free of VRE colonization. Qualitative PCR results were concordant with culture. Six patients received antibiotics during follow-up, three in each group. No adverse events were reported.
CRE and VRE clearance rates were not significantly different in this study, possibly due to the small sample size, but a trend was observed. These data should be confirmed by larger cohorts and randomized trials.
全球范围内耐碳青霉烯肠杆菌科（CRE）和万古霉素耐药肠球菌（VRE）的携带率正在上升。粪便微生物群移植（FMT）似乎是一种有吸引力的去定植选择。本研究旨在评估 FMT 对携带 CRE 和 VRE 的患者的清除效果。
本研究是一项多中心试验，纳入了 2015 年 1 月至 2017 年 4 月期间接受 FMT 的 CRE 或 VRE 消化道定植患者。研究纳入了 CRE 或 VRE 定植的成年患者，通过每周一次连续三次直肠拭子确认，包括在 FMT 前一周的一次。排除在 FMT 时存在免疫抑制或同时使用抗生素的患者。成功去定植定义为在 FMT 后第 7、14、21 和 28 天，以及随后三个月每月至少两次连续两次直肠拭子（聚合酶链反应（PCR）和培养）阴性。
共纳入 17 例患者，中位年龄为 73 岁（四分位距 64.3-79.0）。FMT 前 CRE 或 VRE 携带的中位时间为 62.5 天（四分位距 57.0-77.5）。FMT 后一周，8 例 CRE 定植患者中有 3 例、9 例 VRE 定植患者中有 3 例清除。3 个月后，8 例 CRE 定植患者中有 4 例、8 例 VRE 定植患者中有 7 例清除。定性 PCR 结果与培养结果一致。6 例患者在随访期间接受了抗生素治疗，每组 3 例。未报告不良事件。
本研究中，CRE 和 VRE 的清除率没有显著差异，可能是由于样本量小，但观察到一种趋势。这些数据需要更大的队列和随机试验来证实。
