Fecal microbiota transplantation shortens the colonization period and allows the re-entry of patients carrying carbapenamase-producing bacteria into medical care facilities

Nadia Saïdani (1) , Jean-Christophe J.-C. Lagier (2, 1) , Nadim Cassir (3) , Matthieu Million (2) , Sophie Baron (4, 2) , Gregory Dubourg (2, 4) , Carole Eldin (5) , Jad Kerbaj (1) , Camille Valles (2, 1) , Didier Raoult (2) , Philippe Brouqui (2)

1 IHU Marseille - Institut Hospitalier Universitaire Méditerranée Infection
2 MEPHI - Microbes évolution phylogénie et infections
3 APHM - Assistance Publique - Hôpitaux de Marseille
4 AMU PHARM - Aix-Marseille Université - Faculté de pharmacie
5 VITROME - Vecteurs - Infections tropicales et méditerranéennes

Background: Colonisation with carbapenemase-producing Enterobacteriaceae or Acinetobacter (CPE/A) is associated with complex medical care requiring implementation of specific isolation policies and limitation of patient discharge to other medical facilities. Faecal microbiota transplantation (FMT) has been proposed in order to reduce the duration of gut colonisation. Objectives: This study investigated whether a dedicated protocol of FMT could reduce the negativation time of CPE/A intestinal carriage in patients whose medical care has been delayed due to such colonisa-tion. Method: A matched case-control retrospective study between patients who received FMT treatment and those who did not among CPE/A-colonised patients addressed for initial clustering at the current institute. The study adjusted two controls per case based on sex, age, bacterial species, and carbapenemase type. The primary outcome was delay in negativation of rectal-swab cultures. Results: At day 14 post FMT, 8/10 (80%) treated patients were cleared for intestinal CPE/A carriage. In the control group, 2/20 (10%) had spontaneous clearance at day 14 after CPE/A diagnosis. Faecal micro-biota transplantation led patients to reduce the delay in decolonisation (median 3 days post FMT for treated patients vs. 50.5 days after the first documentation of digestive carriage for control patients) and discharge from hospital (median 19.5 days post FMT for treated patients vs. 41 for control patients). Conclusion: Faecal microbiota transplantation is a safe and time-saving procedure to discharge CPE/A-colonised patients from the hospital. A standardised protocol, including 5 days of antibiotic treatment, bowel cleansing and systematic indwelling devices removal, should improve protocol effectiveness.

Mots clés: Multidrug-resistant bacteriae; Enterobacteriaceae; Faecal microbiota transplantation; Decolonisation; Carbapenem-resistant

Domaines: Bactériologie; Maladies infectieuses

Nadia Saïdani, Jean-Christophe J.-C. Lagier, Nadim Cassir, Matthieu Million, Sophie Baron, et al.. Fecal microbiota transplantation shortens the colonization period and allows the re-entry of patients carrying carbapenamase-producing bacteria into medical care facilities. International Journal of Antimicrobial Agents, 2019, 53 (4), pp.355-361. ⟨10.1016/j.ijantimicag.2018.11.014⟩. ⟨hal-02006702⟩