Benjamin Davido1, Rui Batista2, Aurélien Dinh3, Pierre de Truchis3, E M Terveer4, Bruce Roberts5, Ed J Kuijper4, Silvia Caballero5. 1. Maladies Infectieuses, Hôpital Universitaire Raymond-Poincaré, Groupe Hospitalier Paris Ile de France Ouest, AP-HP, Garches, France. Electronic address: benjamin.davido@aphp.fr. 2. Pharmacie Hospitalière, Hôpital Universitaire Cochin, AP-HP, Paris, France. 3. Maladies Infectieuses, Hôpital Universitaire Raymond-Poincaré, Groupe Hospitalier Paris Ile de France Ouest, AP-HP, Garches, France. 4. Department of Medical Microbiology, Leiden, The Netherlands; Netherlands Donor Faeces Bank at Leiden University Medical Centre, Leiden, The Netherlands. 5. Vedanta Biosciences Inc., Cambridge, MA, USA.
Abstract
BACKGROUND: Spontaneous decolonization of antibiotic-resistant bacteria (ARB) takes time: approximately 25% after 30 days for carbapenem-producing Enterobacteriaceae or extended-spectrum beta-lactamase-producing Enterobacteriaceae. Faecal microbiota transplantation (FMT) has been proposed as a new strategy to promote decolonization in order to reduce the risk of superinfection due to these ARB. This paper discusses the literature on the use of FMT for this indication, and the improvement levers available to promote its efficacy. METHODS: Literature available to date concerning the use of FMT to eradicate ARB was reviewed, and the different factors that may have influenced the efficacy of decolonization were evaluated. RESULTS: Four axes that could have played major roles in the efficacy of FMT were identified: bowel preparation before FMT; donor; dose; and thermal conditioning of faeces. The positive or negative impact of each on the outcome of FMT is discussed. CONCLUSION: Although FMT is very efficient for the eradication of Clostridium difficile, the same 'recipe' cannot be used for the eradication of ARB. Working together with expert centres may help to improve the efficacy of FMT for this indication, and enable the reduction of in-hospital isolation precautions.
BACKGROUND: Spontaneous decolonization of antibiotic-resistant bacteria (ARB) takes time: approximately 25% after 30 days for carbapenem-producing Enterobacteriaceae or extended-spectrum beta-lactamase-producing Enterobacteriaceae. Faecal microbiota transplantation (FMT) has been proposed as a new strategy to promote decolonization in order to reduce the risk of superinfection due to these ARB. This paper discusses the literature on the use of FMT for this indication, and the improvement levers available to promote its efficacy. METHODS: Literature available to date concerning the use of FMT to eradicate ARB was reviewed, and the different factors that may have influenced the efficacy of decolonization were evaluated. RESULTS: Four axes that could have played major roles in the efficacy of FMT were identified: bowel preparation before FMT; donor; dose; and thermal conditioning of faeces. The positive or negative impact of each on the outcome of FMT is discussed. CONCLUSION: Although FMT is very efficient for the eradication of Clostridium difficile, the same 'recipe' cannot be used for the eradication of ARB. Working together with expert centres may help to improve the efficacy of FMT for this indication, and enable the reduction of in-hospital isolation precautions.
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