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Fecal Microbiota Transplantation for Eradicating Carriage of Multidrug-Resistant Organisms: A Systematic Review.
Clin Microbiol Infect. 2019 Apr 12;:
Authors: Saha S, Tariq R, Tosh PK, Pardi DS, Khanna S
Abstract
BACKGROUND: Multidrug resistant (MDR) microorganism development in the gut is frequently secondary to inappropriate antibiotic use. Fecal microbiota transplantation (FMT) restores normal gut microbiota in patients with C difficile infection; we hypothesized that it may help in decolonizing MDR organisms (MDROs) and in preventing recurrent MDR infections.
OBJECTIVES: To assess FMT efficacy (eradication rate) for decolonizing MDROs and preventing recurrent MDR infections.
DATA SOURCES: MEDLINE, EMBASE, and Web of Science (inception through February 11, 2019).
STUDY ELIGIBILITY CRITERIA: Clinical trials, retrospective studies, case reports, and case series.
PARTICIPANTS: Patients with MDR infections or MDRO colonization treated with FMT.
INTERVENTIONS: FMT.
METHODS: Systematic review.
RESULTS: Twenty-one studies (1 randomized clinical trial, 7 uncontrolled clinical trials, 2 retrospective cohort studies, 2 case series, 9 case reports) with 192 patients were included. Three studies assessed FMT efficacy in preventing MDR infections; 16 assessed its effect on MDRO colonization; 2 assessed both. Data from 151 patients were included in the final analyses. In studies with low to moderate risk of bias, the eradication rate was 37.5% to 87.5%. Efficacy was similar in studies looking at infection or colonization and did not differ by length of follow-up. No serious adverse events from FMT were reported. Seven patients died of other causes.
CONCLUSIONS: FMT could be used as a treatment for eradicating MDR colonization and, possibly, preventing recurrent MDR infections, once more supporting efficacy and safety data are available. Larger, well-designed randomized controlled trials are needed to further explore this therapy.
PMID: 30986562 [PubMed - as supplied by publisher]