Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, China.
Institute of Hematology, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China.
Eur J Med Res. 2021 Apr 28;26(1):37. doi: 10.1186/s40001-021-00508-8.
Due to limited antibiotic options, carbapenem-resistant Enterobacteriaceae (CRE) infections are associated with high non-relapse mortality after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Also, intestinal CRE colonization is a risk factor for subsequent CRE infection. Several clinical studies have reported successful fecal microbiota transplantation (FMT) for the gut decontamination of a variety of multidrug-resistant bacteria (MDRB), even in immunosuppressed patients. Similarly, other studies have also indicated that multiple FMTs may increase or lead to successful therapeutic outcomes.
We report CRE colonization in an allo-HSCT patient with recurrent CRE infections, and its successful eradication using tandem FMT cycles at 488 days after allo-HSCT. We also performed a comprehensive microbiota analysis. No acute or delayed adverse events (AEs) were observed. The patient remained clinically stable with CRE-negative stool culture at 26-month follow-up. Our analyses also showed some gut microbiota reconstruction. We also reviewed the current literature on decolonization strategies for CRE.
CRE colonization led to a high no-relapse mortality after allo-HSCT; however, well-established decolonization strategies are currently lacking. The successful decolonization of this patient suggests that multiple FMT cycles may be potential options for CRE decolonization.
由于抗生素选择有限，碳青霉烯类耐药肠杆菌科（CRE）感染与异基因造血干细胞移植（allo-HSCT）后非复发死亡率高有关。此外，肠道 CRE 定植是随后发生 CRE 感染的危险因素。几项临床研究报告了粪便微生物群移植（FMT）在多种多药耐药菌（MDRB）肠道去污染方面的成功应用，即使在免疫抑制患者中也是如此。同样，其他研究也表明，多次 FMT 可能会增加或导致成功的治疗结果。
我们报告了一例 allo-HSCT 患者在 allo-HSCT 后 488 天出现复发性 CRE 感染和 CRE 定植，使用串联 FMT 周期成功清除。我们还进行了全面的微生物组分析。未观察到急性或迟发性不良事件（AE）。在 26 个月的随访中，患者仍保持临床稳定，CRE 粪便培养阴性。我们的分析还显示了一些肠道微生物组的重建。我们还回顾了目前关于 CRE 去定植策略的文献。
allo-HSCT 后 CRE 定植导致非复发死亡率高；然而，目前缺乏成熟的去定植策略。该患者成功去定植表明，多次 FMT 周期可能是 CRE 去定植的潜在选择。
