Q&A: FMT for fecal decolonization of antibiotic-resistant organisms

Early evidence suggests that fecal microbiota transplantation, or FMT, an established treatment for recurrent Clostridioides difficile infection, may be able to reduce intestinal colonization of antibiotic-resistant organisms, although more research is needed to determine its safety and efficacy, researchers reported.

Writing in Open Forum Infectious Diseases, Jennie H. Kwon, DO, MSCI, assistant professor of medicine in the division of infectious diseases at the Washington University School of Medicine in St. Louis, and colleagues summarized available clinical findings and “outlined a practical research agenda that we believe will improve our current understanding of the safety and efficacy of FMT for [antibiotic-resistant organism (ARO)] colonization, and potentially improve patient care.”

Infectious Disease News asked Kwon about their findings and what type of research is needed going forward. – by Caitlyn Stulpin

What makes this an intriguing area of study?

We live in an era where the rate of antimicrobial resistance is growing faster than the rate of new antimicrobial treatment options. That said, we need to create safe and effective methods to prevent antimicrobial resistance and reduce reservoirs for AROs. Microbiome therapies such as FMT are an area of great interest because some case reports and studies have shown that FMT can reduce intestinal ARO colonization in some individuals. This finding is key, because the intestinal microbiota can be a reservoir for AROs, which can later lead to ARO infections. Although some of the initial findings are promising, there are significant limitations to the available data, and further research is necessary to understand the role of FMT in our current medical armamentarium.

What are some of the limitations of the published studies?

There are multiple studies and case reports that have been published involving the use of FMT, however, there is great variability in the types and doses of FMT products used, the route of administration and how recipients were selected. There are even further limitations on how we measure outcomes related to FMT, and the long-term safety and outcome data available.

What type of research is needed going forward?

Microbiome therapies are a great area of interest for the medical community, patients and researchers. To move the field forward, we need further research to first and foremost understand the safety and efficacy of FMT for treatment or prevention of disease. We should not just focus on short-term outcomes but longer term implications of microbiome therapies. We need research in the composition of the microbial communities that are most beneficial, the types of recipients who would most benefit, host factors and the donor selection. As the research moves forward, we need to work with the appropriate regulatory bodies and ethicists to delineate the framework wherein microbiome therapies can and should be administered. We need randomized, placebo-controlled trials to understand the role of FMT in treatment of disease.

The FDA recently issued a safety alert on FMT after a patient died . Should patients be concerned about short- or long-term risks associated with FMT?

This is a very unfortunate outcome that requires us to work harder to understand the risks and safety surrounding the use of microbiome therapies. Patient safety should be at the forefront when considering the use of FMT, and the risks vs. benefits should be carefully weighed. As we continue to research the role of FMT for treatment and prevention of disease, we need to ensure we measure both the short- and long-term safety data.

Disclosure: Kwon reports no relevant financial disclosures.

Early evidence suggests that fecal microbiota transplantation, or FMT, an established treatment for recurrent Clostridioides difficile infection, may be able to reduce intestinal colonization of antibiotic-resistant organisms, although more research is needed to determine its safety and efficacy, researchers reported.

Writing in Open Forum Infectious Diseases, Jennie H. Kwon, DO, MSCI, assistant professor of medicine in the division of infectious diseases at the Washington University School of Medicine in St. Louis, and colleagues summarized available clinical findings and “outlined a practical research agenda that we believe will improve our current understanding of the safety and efficacy of FMT for [antibiotic-resistant organism (ARO)] colonization, and potentially improve patient care.”

Infectious Disease News asked Kwon about their findings and what type of research is needed going forward. – by Caitlyn Stulpin

What makes this an intriguing area of study?

We live in an era where the rate of antimicrobial resistance is growing faster than the rate of new antimicrobial treatment options. That said, we need to create safe and effective methods to prevent antimicrobial resistance and reduce reservoirs for AROs. Microbiome therapies such as FMT are an area of great interest because some case reports and studies have shown that FMT can reduce intestinal ARO colonization in some individuals. This finding is key, because the intestinal microbiota can be a reservoir for AROs, which can later lead to ARO infections. Although some of the initial findings are promising, there are significant limitations to the available data, and further research is necessary to understand the role of FMT in our current medical armamentarium.

What are some of the limitations of the published studies?

There are multiple studies and case reports that have been published involving the use of FMT, however, there is great variability in the types and doses of FMT products used, the route of administration and how recipients were selected. There are even further limitations on how we measure outcomes related to FMT, and the long-term safety and outcome data available.

What type of research is needed going forward?

Microbiome therapies are a great area of interest for the medical community, patients and researchers. To move the field forward, we need further research to first and foremost understand the safety and efficacy of FMT for treatment or prevention of disease. We should not just focus on short-term outcomes but longer term implications of microbiome therapies. We need research in the composition of the microbial communities that are most beneficial, the types of recipients who would most benefit, host factors and the donor selection. As the research moves forward, we need to work with the appropriate regulatory bodies and ethicists to delineate the framework wherein microbiome therapies can and should be administered. We need randomized, placebo-controlled trials to understand the role of FMT in treatment of disease.

The FDA recently issued a safety alert on FMT after a patient died . Should patients be concerned about short- or long-term risks associated with FMT?

This is a very unfortunate outcome that requires us to work harder to understand the risks and safety surrounding the use of microbiome therapies. Patient safety should be at the forefront when considering the use of FMT, and the risks vs. benefits should be carefully weighed. As we continue to research the role of FMT for treatment and prevention of disease, we need to ensure we measure both the short- and long-term safety data.

Disclosure: Kwon reports no relevant financial disclosures.