Dr.-Benjamin-Mullish

Fecal Microbiota Transplant For Multi-Drug-Resistant Organisms: Improved clinical Outcomes Beyond Intestinal Decolonization

MedicalResearch.com Interview with:

Prof. Julian Marchesi

Prof. Marchesi

Prof. Julian Marchesi PhD
Professor of Digestive Health
Faculty of Medicine, Department of Metabolism, Digestion and Reproduction

 

Dr.-Benjamin-Mullish

Prof. Mullish

Dr. Benjamin Mullish PhD
Faculty of Medicine, Department of Metabolism, Digestion and Reproduction
NIHR Clinical Lecturer

Imperial College London

 

 

 

MedicalResearch.com: What is the background for this study?

Response: Many patients are colonized with bacteria that are resistant to nearly all the antibiotics that we currently have. This antibiotic resistance is a huge public health problem, not least because it may lead to the scenario where a bacterial species moves from the gut and into the bloodstream, causes an infection, and cannot be treated. Such scenarios particularly occur in patients who are particularly prone to getting multiple and frequent courses of antibiotics; this may include patients with particular kidney conditions (who may be vulnerable to recurrent urinary tract infections (UTIs)), and patients with blood cancers (such as leukaemia, who have weak immune systems and are therefore prone to infections).

Furthermore, in both sets of patients, to help treat their disease, they may be offered transplants, either a new kidney or new bone marrow. When this transplant happens, the clinician needs to ‘switch off’ their immune system to allow the transplant to work. When the immune system is dialled down, it can no longer stop any invading bacteria, increasing the chance of antibiotic resistance bacteria causing infections, which frequently leads to patient death. 

MedicalResearch.com: What are the main findings?

Response: So, if we cannot treat these bacteria with antibiotics, what do we do? Recently we and others have discovered that faecal microbiota transplants (FMT) can treat guts infected with a form of gut bacteria named Clostridioides difficile, and so we wondered if this could also treat patients who are colonized with bacteria that are resistant to antibiotics too. In a small pilot study of renal and haematological patients, who were all colonized with bacteria resistant to nearly all the antibiotics we have, we tried FMT. So we took a stool sample from a screened healthy donor, and placed into the guts of these patients, using a tube down the nose and into their upper gut. The procedure was overall safe and well-tolerated by patients, with no severe complications.

In 41% of the patients treated with an faecal microbiota transplants, we decolonized their guts of the antibiotic-resistant bacteria. We also found that the time they stayed in hospital, the numbers of bloodstream infections from the antibiotic resistant bacteria, the total number of bloodstream infections, and the amount of a particular class to strong antibiotics (called carbapenems) that they needed to take, were ALL reduced. Also, in the kidney patients, the number UTIs that were reported after the FMT was also reduced. One of the most interesting findings was that we did not have to get rid of the antibiotic resistance bacteria completely to make an impact upon important clinical outcomes and the quality of life of the patients, which tells us we should also be looking at other measures of health and not just whether we got rid of the antibiotic resistant bacteria.

MedicalResearch.com: What should readers take away from your report?

Response: New treatments are being developed to treat antibiotic resistant bacteria that do not rely on new antibiotics and are ready for testing now.

Faecal microbiota transplants is safe and well-tolerated, even in patients whose immune systems have been dialed down.

Sometimes treatment success is not obvious, for example the removal of the antibiotic resistant bacteria from the gut is not always needed to make a big change to the quality of life of a patient.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: We are now testing FMT in more people and trying to understand exactly how it controls the antibiotic resistant bacteria, so we can try and refine the process and develop better treatments.

MedicalResearch.com: Is there anything else you would like to add?

Response: No disclosures that are relevant to this work. Our work was funded by two UK charities – the Medical Research Council (MRC) and the National Institute for Health Research (NIHR).

Citation: 

Fecal microbiota transplant for multi-drug-resistant organisms: Improved clinical outcomes beyond intestinal decolonization
MEETING: Digestive Disease Week (DDW) 2020

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Apr 30, 2020 @ 4:24 pm

 

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