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Fecal microbiota transplant mitigates adverse outcomes in patients colonized with multidrug-resistant organisms undergoing allogeneic hematopoietic cell transplantation

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Title: Fecal microbiota transplant mitigates adverse outcomes in patients colonized with multidrug-resistant organisms undergoing allogeneic hematopoietic cell transplantation
Authors: Innes, AJ
Mullish, BH
Ghani, R
Szydlo, RM
Apperley, JF
Olavarria, E
Palanicawandar, R
Kanfer, EJ
Milojkovic, D
McDonald, JAK
Brannigan, ET
Thursz, MR
Williams, HRT
Davies, FJ
Marchesi, JR
Pavlu, J
Item 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.
Issue Date: 27-Aug-2021
Date of Acceptance: 12-Aug-2021
URI: http://hdl.handle.net/10044/1/91049
DOI: 10.3389/fcimb.2021.684659
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.
Sponsor/Funder: Medical Research Council
Medical Research Council (MRC)
Imperial College Healthcare NHS Trust- BRC Funding
British Infection Association (BIA)
Funder's Grant Number: MR/R00875/1
Keywords: 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
Online Publication Date: 2021-08-27
Appears in Collections:Department of Immunology and Inflammation
Department of Metabolism, Digestion and Reproduction
Faculty of Medicine
Faculty of Natural Sciences

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