Gram-Negative Taxa and Antimicrobial Susceptibility after Fecal Microbiota Transplantation for Recurrent <named-content content-type="genus-species">Clostridioides difficile</named-content> Infection

ABSTRACT Fecal microbiota transplantation (FMT) has promising applications in reducing multidrug-resistant organism (MDRO) colonization and antibiotic resistance (AR) gene abundance. However, data on clinical microbiology results after FMT are limited. We examined the changes in antimicrobial suscep...

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Autores principales:	Danielle Barrios Steed, Tiffany Wang, Divyanshu Raheja, Alex D. Waldman, Ahmed Babiker, Tanvi Dhere, Colleen S. Kraft, Michael H. Woodworth
Formato:	article
Lenguaje:	EN
Publicado:	American Society for Microbiology 2020
Materias:	FMT fecal microbiota transplant recurrent infection C. difficile infection infection microbiome Microbiology QR1-502
Acceso en línea:	https://doaj.org/article/b7397e90fab8459f8a6e9cc067068606
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spelling	oai:doaj.org-article:b7397e90fab8459f8a6e9cc0670686062021-11-15T15:30:58ZGram-Negative Taxa and Antimicrobial Susceptibility after Fecal Microbiota Transplantation for Recurrent <named-content content-type="genus-species">Clostridioides difficile</named-content> Infection10.1128/mSphere.00853-202379-5042https://doaj.org/article/b7397e90fab8459f8a6e9cc0670686062020-10-01T00:00:00Zhttps://journals.asm.org/doi/10.1128/mSphere.00853-20https://doaj.org/toc/2379-5042ABSTRACT Fecal microbiota transplantation (FMT) has promising applications in reducing multidrug-resistant organism (MDRO) colonization and antibiotic resistance (AR) gene abundance. However, data on clinical microbiology results after FMT are limited. We examined the changes in antimicrobial susceptibility profiles in patients with Gram-negative infections in the year before and the year after treatment with FMT for recurrent Clostridioides difficile infection (RCDI). We also examined whether a history of FMT changed health care provider behavior with respect to culture ordering and antibiotic prescription. Medical records for RCDI patients who underwent FMT at Emory University between July 2012 and March 2017 were reviewed retrospectively. FMT-treated patients with Gram-negative culture data in the 1-year period preceding and the 1-year period following FMT were included. Demographic and clinical data were abstracted, including CDI history, frequency of Gram-negative cultures, microbiological results, and antibiotic prescription in response to positive cultures in the period following FMT. Twelve patients were included in this case series. We pooled data from infections at all body sites and found a decrease in the number of total and Gram-negative cultures post-FMT. We compared susceptibility profiles across taxa given the potential for horizontal transmission of AR elements and observed increased susceptibility to nitrofurantoin, trimethoprim-sulfamethoxazole, and the aminoglycosides. FMT did not drastically influence health care provider ordering of bacterial cultures or antibiotic prescribing practices. We observed a reduction in Gram-negative cultures and a trend toward increased antimicrobial susceptibility. This study supports further investigation of FMT as a means of improving antimicrobial susceptibility. IMPORTANCE Fecal microbiota transplantation (FMT), which is highly efficacious in treating recurrent C. difficile infection (RCDI), has a promising application in decolonization of multidrug-resistant organisms, reduction of antibiotic resistance gene abundance, and restoration of healthy intestinal microbiota. However, data representing clinical microbiology results after FMT are limited. We sought to characterize the differences in culture positivity and antimicrobial susceptibility profiles in patients with Gram-negative infections in the year before and the year after FMT for RCDI. Drawing on prior studies that had demonstrated the success of FMT in eradicating extraintestinal infections and the occurrence of patient-level interspecies transfer of resistance elements, we employed an agnostic analytic approach of reviewing the data irrespective of body site or species. In a small RCDI population, we observed an improvement in the antimicrobial susceptibility profile of Gram-negative bacteria following FMT, which supports further study of FMT as a strategy to combat antibiotic resistance.Danielle Barrios SteedTiffany WangDivyanshu RahejaAlex D. WaldmanAhmed BabikerTanvi DhereColleen S. KraftMichael H. WoodworthAmerican Society for MicrobiologyarticleFMTfecal microbiota transplantrecurrent infectionC. difficile infectioninfectionmicrobiomeMicrobiologyQR1-502ENmSphere, Vol 5, Iss 5 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	FMT fecal microbiota transplant recurrent infection C. difficile infection infection microbiome Microbiology QR1-502
spellingShingle	FMT fecal microbiota transplant recurrent infection C. difficile infection infection microbiome Microbiology QR1-502 Danielle Barrios Steed Tiffany Wang Divyanshu Raheja Alex D. Waldman Ahmed Babiker Tanvi Dhere Colleen S. Kraft Michael H. Woodworth Gram-Negative Taxa and Antimicrobial Susceptibility after Fecal Microbiota Transplantation for Recurrent <named-content content-type="genus-species">Clostridioides difficile</named-content> Infection
description	ABSTRACT Fecal microbiota transplantation (FMT) has promising applications in reducing multidrug-resistant organism (MDRO) colonization and antibiotic resistance (AR) gene abundance. However, data on clinical microbiology results after FMT are limited. We examined the changes in antimicrobial susceptibility profiles in patients with Gram-negative infections in the year before and the year after treatment with FMT for recurrent Clostridioides difficile infection (RCDI). We also examined whether a history of FMT changed health care provider behavior with respect to culture ordering and antibiotic prescription. Medical records for RCDI patients who underwent FMT at Emory University between July 2012 and March 2017 were reviewed retrospectively. FMT-treated patients with Gram-negative culture data in the 1-year period preceding and the 1-year period following FMT were included. Demographic and clinical data were abstracted, including CDI history, frequency of Gram-negative cultures, microbiological results, and antibiotic prescription in response to positive cultures in the period following FMT. Twelve patients were included in this case series. We pooled data from infections at all body sites and found a decrease in the number of total and Gram-negative cultures post-FMT. We compared susceptibility profiles across taxa given the potential for horizontal transmission of AR elements and observed increased susceptibility to nitrofurantoin, trimethoprim-sulfamethoxazole, and the aminoglycosides. FMT did not drastically influence health care provider ordering of bacterial cultures or antibiotic prescribing practices. We observed a reduction in Gram-negative cultures and a trend toward increased antimicrobial susceptibility. This study supports further investigation of FMT as a means of improving antimicrobial susceptibility. IMPORTANCE Fecal microbiota transplantation (FMT), which is highly efficacious in treating recurrent C. difficile infection (RCDI), has a promising application in decolonization of multidrug-resistant organisms, reduction of antibiotic resistance gene abundance, and restoration of healthy intestinal microbiota. However, data representing clinical microbiology results after FMT are limited. We sought to characterize the differences in culture positivity and antimicrobial susceptibility profiles in patients with Gram-negative infections in the year before and the year after FMT for RCDI. Drawing on prior studies that had demonstrated the success of FMT in eradicating extraintestinal infections and the occurrence of patient-level interspecies transfer of resistance elements, we employed an agnostic analytic approach of reviewing the data irrespective of body site or species. In a small RCDI population, we observed an improvement in the antimicrobial susceptibility profile of Gram-negative bacteria following FMT, which supports further study of FMT as a strategy to combat antibiotic resistance.
format	article
author	Danielle Barrios Steed Tiffany Wang Divyanshu Raheja Alex D. Waldman Ahmed Babiker Tanvi Dhere Colleen S. Kraft Michael H. Woodworth
author_facet	Danielle Barrios Steed Tiffany Wang Divyanshu Raheja Alex D. Waldman Ahmed Babiker Tanvi Dhere Colleen S. Kraft Michael H. Woodworth
author_sort	Danielle Barrios Steed
title	Gram-Negative Taxa and Antimicrobial Susceptibility after Fecal Microbiota Transplantation for Recurrent <named-content content-type="genus-species">Clostridioides difficile</named-content> Infection
title_short	Gram-Negative Taxa and Antimicrobial Susceptibility after Fecal Microbiota Transplantation for Recurrent <named-content content-type="genus-species">Clostridioides difficile</named-content> Infection
title_full	Gram-Negative Taxa and Antimicrobial Susceptibility after Fecal Microbiota Transplantation for Recurrent <named-content content-type="genus-species">Clostridioides difficile</named-content> Infection
title_fullStr	Gram-Negative Taxa and Antimicrobial Susceptibility after Fecal Microbiota Transplantation for Recurrent <named-content content-type="genus-species">Clostridioides difficile</named-content> Infection
title_full_unstemmed	Gram-Negative Taxa and Antimicrobial Susceptibility after Fecal Microbiota Transplantation for Recurrent <named-content content-type="genus-species">Clostridioides difficile</named-content> Infection
title_sort	gram-negative taxa and antimicrobial susceptibility after fecal microbiota transplantation for recurrent <named-content content-type="genus-species">clostridioides difficile</named-content> infection
publisher	American Society for Microbiology
publishDate	2020
url	https://doaj.org/article/b7397e90fab8459f8a6e9cc067068606
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Gram-Negative Taxa and Antimicrobial Susceptibility after Fecal Microbiota Transplantation for Recurrent <named-content content-type="genus-species">Clostridioides difficile</named-content> Infection

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