Одна процедура трансплантации фекальной микробиоты не очистила организм от устойчивых бактерий, но изменила состав микробиома

A single session of FMT did not significantly decolonize multidrug-resistant organisms in the microbiome. Researchers still observed evidence of positive microbiome restructuring with FMT. While a single fecal microbiota transplantation session did not significantly improve multidrug-resistant organism decolonization among patients with gastrointestinal disease, it may prompt microbiome restructuring, study results showed. Researchers noted that the enrichment of certain bacteria among patients in the FMT cohort, which was not observed in a sham intervention cohort, warrants further research. “These findings should be interpreted in the context of the specific patient population and the single session FMT protocol used, and should not be taken as refuting microbiota-based therapeutic approaches as potential strategies for [multidrug-resistant organisms] decolonization,” Himanshu Narang, DM,assistant professor in the department of gastroenterology and human nutrition at All India Institute of Medical Sciences, and colleagues wrote. “This study also found that FMT induced shifts in the gut microbiome,” they added. “Notably, bacteria with capacity to produce short chain fatty acids, such as Dorea, Holdemanella, Lachnospira, Agathobacter and Eubacterium, were enriched following FMT, suggesting a shift toward gut microbial communities that support gut health and metabolic function.” Because of a lack of FDA-approved therapies to prevent infection from multidrug-resistant organisms (MDRO), Narang and colleagues decided to conduct a randomized, sham-controlled study to assess efficacy of FMT in promoting MDRO decolonization and/or decreasing antimicrobial resistance genes. The study included 114 patients aged 18 to 75 years (70.2% men; mean age, 40.6 years) with GI diseases and persistent MDRO colonization. They were studied in a gastroenterology ward and ICU at a tertiary care center in India. Of the trial population, 58 patients received FMT via colonoscopy and 56 patients received a sham intervention. Patients had previously been diagnosed with pancreatitis (45.6%), cirrhosis (37.7%) or other GI disorders (16.7%). At baseline, the majority of patients (FMT group, 94.8%; sham group, 100%) were colonized with carbapenem-resistant Enterobacteriaceae or extended spectrum beta-lactamase-producing Enterobacteriaceae. MDRO decolonization rate and decrease in antimicrobial resistance genes at 4 weeks served as coprimary endpoints. Secondary endpoints included changes in stool microbiome, among others. After the intervention, data showed no significant difference between FMT and sham groups in MDRO decolonization (31% vs. 30.4%; absolute difference, 0.6%; 95% CI, –16.2% to 17.6%) or antimicrobial resistance genes (median, 2.5 genes vs. 2 genes). However, gene-sequencing analysis conducted among 71 patients (FMT group, n = 38; sham group, n = 33) 4 to 6 weeks after the intervention showed microbial diversity increased, but did not reach donor levels. No significant differences were observed among patients from the sham group. Researchers acknowledged study limitations, including its heterogeneous study population, not assessing potential influence of diet to MDRO decolonization and performing MDRO decolonization assessments only 4 weeks after the intervention. They said that additional large, multicenter studies are needed to help determine FMT’s place in gut MDRO decolonization.