Emory University School of Medicine, Atlanta, Georgia, USA.
Emory University School of Medicine, Department of Pathology and Laboratory Medicine, Atlanta, Georgia, USA.
mSphere. 2020 Oct 14;5(5):e00853-20. doi: 10.1128/mSphere.00853-20.
Fecal microbiota transplantation (FMT) has promising applications in reducing multidrug-resistant organism (MDRO) colonization and antibiotic resistance (AR) gene abundance. However, data on clinical microbiology results after FMT are limited. We examined the changes in antimicrobial susceptibility profiles in patients with Gram-negative infections in the year before and the year after treatment with FMT for recurrent infection (RCDI). We also examined whether a history of FMT changed health care provider behavior with respect to culture ordering and antibiotic prescription. Medical records for RCDI patients who underwent FMT at Emory University between July 2012 and March 2017 were reviewed retrospectively. FMT-treated patients with Gram-negative culture data in the 1-year period preceding and the 1-year period following FMT were included. Demographic and clinical data were abstracted, including CDI history, frequency of Gram-negative cultures, microbiological results, and antibiotic prescription in response to positive cultures in the period following FMT. Twelve patients were included in this case series. We pooled data from infections at all body sites and found a decrease in the number of total and Gram-negative cultures post-FMT. We compared susceptibility profiles across taxa given the potential for horizontal transmission of AR elements and observed increased susceptibility to nitrofurantoin, trimethoprim-sulfamethoxazole, and the aminoglycosides. FMT did not drastically influence health care provider ordering of bacterial cultures or antibiotic prescribing practices. We observed a reduction in Gram-negative cultures and a trend toward increased antimicrobial susceptibility. This study supports further investigation of FMT as a means of improving antimicrobial susceptibility. Fecal microbiota transplantation (FMT), which is highly efficacious in treating recurrent infection (RCDI), has a promising application in decolonization of multidrug-resistant organisms, reduction of antibiotic resistance gene abundance, and restoration of healthy intestinal microbiota. However, data representing clinical microbiology results after FMT are limited. We sought to characterize the differences in culture positivity and antimicrobial susceptibility profiles in patients with Gram-negative infections in the year before and the year after FMT for RCDI. Drawing on prior studies that had demonstrated the success of FMT in eradicating extraintestinal infections and the occurrence of patient-level interspecies transfer of resistance elements, we employed an agnostic analytic approach of reviewing the data irrespective of body site or species. In a small RCDI population, we observed an improvement in the antimicrobial susceptibility profile of Gram-negative bacteria following FMT, which supports further study of FMT as a strategy to combat antibiotic resistance.
粪便微生物群移植（FMT）在减少多药耐药菌（MDRO）定植和抗生素耐药（AR）基因丰度方面具有广阔的应用前景。然而，关于 FMT 后临床微生物学结果的数据有限。我们研究了 FMT 治疗复发性感染（RCDI）后患者革兰氏阴性感染的抗菌药物敏感性谱的变化。我们还研究了 FMT 史是否改变了卫生保健提供者在培养物订购和抗生素处方方面的行为。我们回顾性地审查了 2012 年 7 月至 2017 年 3 月期间在埃默里大学接受 FMT 的 RCDI 患者的病历。纳入了在 FMT 前 1 年和 FMT 后 1 年内有革兰氏阴性培养数据的 FMT 治疗患者。提取了人口统计学和临床数据，包括 CDI 病史、革兰氏阴性培养的频率、微生物学结果以及 FMT 后阳性培养物的抗生素处方。这项病例系列研究纳入了 12 名患者。我们将来自所有部位感染的数据进行了汇总，发现 FMT 后总的和革兰氏阴性培养物的数量减少了。我们比较了不同分类群的药敏谱，因为 AR 元素的水平传播的可能性，观察到对呋喃妥因、复方磺胺甲噁唑和氨基糖苷类药物的敏感性增加。FMT 并没有极大地影响卫生保健提供者对细菌培养物的订购或抗生素处方的习惯。我们观察到革兰氏阴性培养物的减少和抗菌药物敏感性增加的趋势。这项研究支持进一步研究 FMT 作为提高抗菌药物敏感性的一种手段。FMT 在治疗复发性感染（RCDI）方面非常有效，它在减少多药耐药菌的定植、降低抗生素耐药基因丰度和恢复健康的肠道微生物群方面具有广阔的应用前景。然而，代表 FMT 后临床微生物学结果的数据有限。我们试图描述 RCDI 患者在接受 FMT 治疗前后一年中革兰氏阴性感染的培养阳性率和抗菌药物敏感性谱的差异。借鉴先前的研究，这些研究表明 FMT 可以成功根除肠外感染，并且在患者水平上发生抗性元素的种间转移，我们采用了一种不关注身体部位或物种的分析方法来审查数据。在一个较小的 RCDI 人群中，我们观察到 FMT 后革兰氏阴性细菌的抗菌药物敏感性谱得到改善，这支持了进一步研究 FMT 作为对抗抗生素耐药性的一种策略。
