Fifty shades of graft: How to improve the efficacy of faecal microbiota transplantation for decolonization of antibiotic-resistant bacteria
Fifty shades of graft: How to improve the efficacy of faecal microbiota transplantation for decolonization of antibiotic-resistant bacteria
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DOI：
10.1016/j.ijantimicag.2019.03.008
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发表时间：
2019-05-01
影响因子：
10.8
通讯作者：
Caballero, Silvia
中科院分区：
文献类型：
--
作者：
Davido, Benjamin;Batista, Rui;Caballero, Silvia
背景：抗生素耐药菌 (ARB) 的自发去定植需要时间：对于产碳青霉烯类肠杆菌科或产广谱 β-内酰胺酶肠杆菌科细菌，30 天后约 25% 发生。粪便微生物群移植（FMT）已被提议作为促进去定植的新策略，以降低这些 ARB 引起的重复感染的风险。本文讨论了关于使用 FMT 治疗该适应症的文献，以及可用于促进其疗效的改进手段。方法：回顾了迄今为止有关使用 FMT 根除 ARB 的文献，并对可能影响去定植疗效的不同因素进行了评估。结果：确定了可能在 FMT 疗效中发挥主要作用的四个轴：FMT 前的肠道准备；捐助者；剂量;和粪便的热调节。讨论了每种方法对 FMT 结果的正面或负面影响。结论：虽然 FMT 对于根除艰难梭菌非常有效，但相同的“配方”不能用于根除 ARB。与专家中心合作可能有助于提高 FMT 针对该适应症的疗效，并减少院内隔离预防措施。 (C) 2019 Elsevier B.V. 和国际化疗协会。版权所有。
Background: Spontaneous decolonization of antibiotic-resistant bacteria (ARB) takes time: approximately 25% after 30 days for carbapenem-producing Enterobacteriaceae or extended-spectrum beta-lactamase-producing Enterobacteriaceae. Faecal microbiota transplantation (FMT) has been proposed as a new strategy to promote decolonization in order to reduce the risk of superinfection due to these ARB. This paper discusses the literature on the use of FMT for this indication, and the improvement levers available to promote its efficacy.Methods: Literature available to date concerning the use of FMT to eradicate ARB was reviewed, and the different factors that may have influenced the efficacy of decolonization were evaluated.Results: Four axes that could have played major roles in the efficacy of FMT were identified: bowel preparation before FMT; donor; dose; and thermal conditioning of faeces. The positive or negative impact of each on the outcome of FMT is discussed.Conclusion: Although FMT is very efficient for the eradication of Clostridium difficile, the same 'recipe' cannot be used for the eradication of ARB. Working together with expert centres may help to improve the efficacy of FMT for this indication, and enable the reduction of in-hospital isolation precautions. (C) 2019 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.