Faculty of Medicine, UNIDES University, Managua 11001, Nicaragua.
Faculty of Medicine, Hanoi Medical University, Hanoi 116001, Vietnam.
J Infect. 2022 Jun;84(6):749-759. doi: 10.1016/j.jinf.2022.04.028. Epub 2022 Apr 21.
The prevalence of Carbapenem-resistant Enterobacteriaceae (CRE) has increased dramatically in recent years and has become a global public health issue. Since carbapenems are considered the last drugs of choice, infections caused by these pathogens are difficult to treat and carry a high risk of mortality. Several antibiotic combination regimens have been utilized for the management of CRE infections or to eradicate colonization in CRE carriers with variable clinical responses. In addition, recent studies have explored the use of fecal microbiota transplantation (FMT) to eradicate CRE infections. Here, we conducted a systematic review of publications in which FMT was used to eliminate CRE colonization in infected individuals. We searched the PubMed, Cochrane, and Medline databases up to November 30, 2021. Ten studies (209 patients) met the inclusion criteria for this review with three articles describing retrospective cohorts (n = 53 patients) and seven reporting prospective data (n = 156 patients), including one randomized open-label clinical trial. All studies were published between 2017 and 2021 with eight studies from Europe and two from South Korea. There were substantial variations in terms of outcome measurements and study endpoint among these studies. Among the 112 FMT recipients with confirmed CRE colonization, CRE decolonization was reported in 55/90 cases at one month after FMT and at the end of the study follow-up (6-12 months), decolonization was documented in 74/94 (78.7%) patients. The predominant CRE strains reported were Klebsiella pneumoniae and Escherichia coli and the most frequently documented carbapenemases were KPC, OXA-48, and NDM. In general, FMT was well tolerated, with no severe complications reported even in immunosuppressed patients and in those with multiple underlying conditions. In conclusion, FMT appears to be safe and effective in eradicating CRE colonization, however, more studies, especially randomized trials, are needed to validate the safety and clinical utility of FMT for CRE eradication.
近年来，碳青霉烯类耐药肠杆菌科（CRE）的流行率显著增加，已成为全球公共卫生问题。由于碳青霉烯类被认为是最后的选择药物，因此由这些病原体引起的感染难以治疗，死亡率很高。已经使用了几种抗生素联合方案来治疗 CRE 感染或消除 CRE 携带者的定植，临床反应各不相同。此外，最近的研究还探讨了使用粪便微生物群移植（FMT）来根除 CRE 感染。在这里，我们对使用 FMT 消除感染个体中 CRE 定植的出版物进行了系统评价。我们检索了截至 2021 年 11 月 30 日的 PubMed、Cochrane 和 Medline 数据库。有 10 项研究（209 名患者）符合本综述的纳入标准，其中 3 篇文章描述了回顾性队列（n=53 名患者），7 篇报告了前瞻性数据（n=156 名患者），包括一项随机开放标签临床试验。所有研究均发表于 2017 年至 2021 年之间，其中 8 项来自欧洲，2 项来自韩国。这些研究在结果测量和研究终点方面存在很大差异。在 112 名经确认存在 CRE 定植的 FMT 接受者中，FMT 后 1 个月和研究随访结束时（6-12 个月）报告了 55/90 例 CRE 去定植，74/94（78.7%）患者记录了去定植。报告的主要 CRE 菌株为肺炎克雷伯菌和大肠埃希菌，最常见的碳青霉烯酶为 KPC、OXA-48 和 NDM。一般来说，FMT 耐受性良好，即使在免疫抑制患者和患有多种基础疾病的患者中，也没有报告严重并发症。总之，FMT 似乎可以安全有效地消除 CRE 定植，但需要更多研究，特别是随机试验，以验证 FMT 用于 CRE 根除的安全性和临床实用性。
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