Faecal microbiota transplantation for eradicating carriage of multidrug-resistant organisms: a systematic review

Abstract

Background: Multidrug-resistant (MDR) microorganism development in the gut is frequently the result of inappropriate antibiotic use. Faecal microbiota transplantation (FMT) restores normal gut microbiota in patients with Clostridium 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 11 February 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 (one randomized clinical trial, seven uncontrolled clinical trials, two retrospective cohort studies, two case series, nine case reports) assessing 192 patients were included. Three studies assessed FMT efficacy in preventing MDR infections; 16 assessed its effect on MDRO colonization; two 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.

Keywords: Antibiotic resistant; Colonization; Decolonization; Faecal microbiota transplantation; Multidrug-resistant infection; Multidrug-resistant organism.