Department of Infectious Diseases.
Department of Medical Microbiology, Leiden University Medical Centre, Leiden.
Curr Opin Gastroenterol. 2022 Jan 1;38(1):15-25. doi: 10.1097/MOG.0000000000000792.
Antimicrobial resistance is a rising threat to global health and is associated with increased mortality. Intestinal colonisation with multidrug-resistant organisms (MDRO) can precede invasive infection and facilitates spread within communities and hospitals. Novel decolonisation strategies, such as faecal microbiota transplantation (FMT), are being explored. The purpose of this review is to provide an update on how the field of FMT for MDRO decolonisation has developed during the past year and to assess the efficacy of FMT for intestinal MDRO decolonisation.
Since 2020, seven highly heterogenous, small, nonrandomised cohort studies and five case reports have been published. In line with previous literature, decolonisation rates ranged from 20 to 90% between studies and were slightly higher for carbapenem-resistant Enterobacteriaceae than vancomycin-resistant Enterococcus. Despite moderate decolonisation rates in two studies, a reduction in MDRO bloodstream and urinary tract infections was observed.
Although a number of smaller cohort studies show some effect of FMT for MDRO decolonisation, questions remain regarding the true efficacy of FMT (taking spontaneous decolonisation into account), the optimal route of administration, the role of antibiotics pre and post-FMT and the efficacy in different patient populations. The observed decrease in MDRO infections post-FMT warrants further research.
抗微生物药物耐药性对全球健康构成日益严重的威胁，并与死亡率升高有关。肠道定植多种耐药菌（MDRO）可先于侵袭性感染，并促进社区和医院内的传播。正在探索新型去定植策略，如粪便微生物群移植（FMT）。本综述的目的是提供过去一年中 MDRO 去定植的 FMT 领域发展的最新情况，并评估 FMT 对肠道 MDRO 去定植的疗效。
自 2020 年以来，已经发表了 7 项高度异质、小型、非随机队列研究和 5 例病例报告。与之前的文献一致，研究之间的去定植率在 20%至 90%之间，碳青霉烯类耐药肠杆菌科的去定植率略高于万古霉素耐药肠球菌。尽管两项研究的去定植率中等，但观察到 MDRO 血流和尿路感染的减少。
尽管一些较小的队列研究显示 FMT 对 MDRO 去定植有一定效果，但关于 FMT 的真实疗效（考虑自发去定植的情况）、最佳给药途径、FMT 前后抗生素的作用以及在不同患者人群中的疗效仍存在疑问。FMT 后 MDRO 感染的减少值得进一步研究。
