Fecal microbiota transplant mitigates adverse outcomes in patients colonized with multidrug-resistant organisms undergoing allogeneic hematopoietic cell transplantation
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Published version
Author(s)
Type
Journal Article
Abstract
The gut microbiome can be adversely affected by chemotherapy and antibiotics prior to hematopoietic cell transplantation (HCT).
This affects graft success and increases susceptibility to multidrug-resistant organism (MDRO) colonization and infection. We
performed an initial retrospective analysis of our use of fecal microbiota transplantation (FMT) from healthy donors as therapy for
MDRO-colonized patients with hematological malignancy. FMT was performed on eight MDRO-colonized patients pre-HCT (FMT-MDRO
group), and outcomes compared with 11 MDRO colonized HCT patients from the same period. At 12 months, survival was
significantly higher in the FMT-MDRO group (70% versus 36% p = 0.044). Post-HCT, fewer FMT-MDRO patients required intensive
care (0% versus 46%, P = 0.045) or experienced fever (0.29 versus 0.11 days, P = 0.027). Intestinal MDRO decolonization occurred in
25% of FMT-MDRO patients versus 11% non-FMT MDRO patients. Despite the significant difference and statistically comparable
patient/transplant characteristics, as the sample size was small, a matched-pair analysis to non-MDRO colonized control cohorts
(2:1 matching) was performed. At 12 months, the MDRO group who did not have an FMT had significantly lower survival (36.4%
versus 61.9% respectively, p=0.012), and higher non relapse mortality (NRM; 60.2% versus 16.7% respectively, p=0.009) than their
paired non-colonized cohort. There was no difference in survival (70% versus 43.4%, p=0.14) or NRM (12.5% versus 31.2%
respectively, p=0.24) between the FMT-MDRO group and their paired cohort. Negative outcomes, including mortality associated
with MDRO colonization, may be ameliorated by pre-HCT FMT, despite lack of intestinal decolonization. Further work is needed to
explore the observed benefit.
This affects graft success and increases susceptibility to multidrug-resistant organism (MDRO) colonization and infection. We
performed an initial retrospective analysis of our use of fecal microbiota transplantation (FMT) from healthy donors as therapy for
MDRO-colonized patients with hematological malignancy. FMT was performed on eight MDRO-colonized patients pre-HCT (FMT-MDRO
group), and outcomes compared with 11 MDRO colonized HCT patients from the same period. At 12 months, survival was
significantly higher in the FMT-MDRO group (70% versus 36% p = 0.044). Post-HCT, fewer FMT-MDRO patients required intensive
care (0% versus 46%, P = 0.045) or experienced fever (0.29 versus 0.11 days, P = 0.027). Intestinal MDRO decolonization occurred in
25% of FMT-MDRO patients versus 11% non-FMT MDRO patients. Despite the significant difference and statistically comparable
patient/transplant characteristics, as the sample size was small, a matched-pair analysis to non-MDRO colonized control cohorts
(2:1 matching) was performed. At 12 months, the MDRO group who did not have an FMT had significantly lower survival (36.4%
versus 61.9% respectively, p=0.012), and higher non relapse mortality (NRM; 60.2% versus 16.7% respectively, p=0.009) than their
paired non-colonized cohort. There was no difference in survival (70% versus 43.4%, p=0.14) or NRM (12.5% versus 31.2%
respectively, p=0.24) between the FMT-MDRO group and their paired cohort. Negative outcomes, including mortality associated
with MDRO colonization, may be ameliorated by pre-HCT FMT, despite lack of intestinal decolonization. Further work is needed to
explore the observed benefit.
Date Issued
2021-08-27
Date Acceptance
2021-08-12
Citation
Frontiers in Cellular and Infection Microbiology, 2021, 11, pp.1-8
ISSN
2235-2988
Publisher
Frontiers Media
Start Page
1
End Page
8
Journal / Book Title
Frontiers in Cellular and Infection Microbiology
Volume
11
Copyright Statement
© 2021 Innes, Mullish, Ghani, Szydlo, Apperley, Olavarria, Palanicawandar, Kanfer, Milojkovic, McDonald, Brannigan, Thursz, Williams, Davies, Marchesi and Pavlů. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
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Sponsor
Medical Research Council
Medical Research Council (MRC)
Imperial College Healthcare NHS Trust- BRC Funding
NIHR
British Infection Association (BIA)
Identifier
https://www.frontiersin.org/articles/10.3389/fcimb.2021.684659/full
Grant Number
MR/R00875/1
MR/R000875/1
RDA02
N/A
Subjects
antimicrobial resistance
fecal microbiota transplant
gut microbiota
hematological malignances
hematopoietic (Stem) cell transplantation (HCT)
multidrug resistant bacteria
0601 Biochemistry and Cell Biology
0605 Microbiology
Publication Status
Published
Article Number
684659
Date Publish Online
2021-08-27