Fecal transplant may benefit some patients with multidrug-resistant organisms

Last Updated: 2020-05-05

By Megan Brooks

NEW YORK (Reuters Health) - Chronically ill patients infected with multidrug-resistant organisms (MDROs) during extensive medical care for serious conditions may benefit from fecal microbiota transplantation (FMT), a pilot study suggests.

"FMT can successfully reduce the risk of bloodstream infections due to antibiotic-resistant gut bacteria and is safe in high-risk patients," study investigator Dr. Julian Marchesi of Cardiff University, in the UK, said during an April 29 press briefing at Digestive Disease Week (DDW).

The study involved 20 patients with intestinal colonization of MDROs, including carbapenemase-producing Enterobacteriaceae and vancomycin-resistant enterococci or extended-spectrum beta-lactamase Enterobacteriaceae (ESBL). The sample included patients with chronic hematological disease in need of stem-cell transplant and kidney-transplant patients with recurrent urinary and bloodstream infections.

All patients underwent a single FMT. They were followed for six months after transplantation and their clinical course was compared with the six months prior to FMT.

MDROs were cleared in seven of the 17 (41%) patients who completed the full six months of follow-up. Despite only "reasonable" levels of intestinal MDRO decolonization, FMT was associated with other "marked clinical benefits," the researchers said in their meeting abstract.

These include a reduction in bloodstream infections with both MDROs specifically (P=0.047) and in all bloodstream infections (P=0.03), shorter hospital stay (P=0.0002) and infections that were much easier to treat than before, as evidenced by fewer number of days on carbapenem (P=0.0005).

Additionally, eight of the 11 patients with chronic hematological disease improved to a point where they were able to undergo stem-cell transplant within six months after FMT, Dr. Marchesi reported.

In a conference statement, lead investigator Dr. Benjamin Mullish of Imperial College London said, "Many of these patients have had recurrent, prolonged courses of heavy-duty antibiotics, end-of- the-line treatments with high toxicity profiles, and repeated hospital stays. They had given up work or had family members forced to give up work to care for them - having a huge impact on quality of life. After this experimental treatment, we saw many in this group being able to go back to work, play with their grandkids and have an overall much better quality of life."

FMT was well-tolerated with no infective or serious adverse events, suggesting that FMT is safe to use in high-risk patients with bloodstream infections, both immunocompromised or immunosuppressed, Dr. Marchesi reported.

It appears that the benefits of FMT on MDROs may stem not only from decolonizing resistant organisms, but also perhaps improving gut barrier function or introducing organisms that compete with MDROs, he suggested.

Dr. Marchesi said the start of a larger trial has been delayed by the COVID-19 pandemic.

SOURCE: https://bit.ly/3bZtSXh Digestive Disease Week (DDW) 2020.