1
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Gulati AS, Nicholson MR, Khoruts A, Kahn SA. Fecal Microbiota Transplantation Across the Lifespan: Balancing Efficacy, Safety, and Innovation. Am J Gastroenterol 2023; 118:435-439. [PMID: 36580630 PMCID: PMC9992015 DOI: 10.14309/ajg.0000000000002167] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 12/21/2022] [Indexed: 12/31/2022]
Abstract
Fecal microbiota transplantation (FMT) is a rapidly growing therapy aimed at reconstituting the dysbiotic microbiota of a patient with the beneficial stool microbiota of a healthy individual. The efficacy rates of FMT are very robust for recurrent Clostridioides difficile infection in both children and adults. Although complications of FMT have been reported, it is generally believed to be a safe procedure. Novel indications for FMT are being studied, with the hope that ultimately it may be useful for a variety of disorders. As this field continues to grow, however, it is necessary to consider efficacy, safety, and innovation across the lifespan. There are unique concerns regarding FMT as it pertains to children, adults, and the elderly. In this review, we seek to update clinicians, researchers, and regulators on how these factors must be balanced across the lifespan as we move forward with this innovative therapy.
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Affiliation(s)
- Ajay S. Gulati
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Maribeth R. Nicholson
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Alexander Khoruts
- Department of Medicine, Division of Gastroenterology, Center for Immunology, University of Minnesota, Minneapolis, MN 55414, USA
| | - Stacy A. Kahn
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Boston, MA 02115, USA
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2
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Reid G. Perspective: microbial interventions in the urinary tract. MICROBIOME RESEARCH REPORTS 2023; 2:3. [PMID: 38045610 PMCID: PMC10688806 DOI: 10.20517/mrr.2022.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/30/2023] [Accepted: 02/14/2023] [Indexed: 12/05/2023]
Abstract
Despite multiple advances in medicine, the management of urinary tract infections (UTIs) in women has remained stalled for decades. To prevent the development of symptomatic recurrences, low-dose antibiotics are the mainstay, while alternative approaches have been attempted with limited success. The use of probiotics was first considered forty years ago, and while some promising studies have been published, additional evidence in larger patient groups is needed to recommend specific strains as a primary preventive regimen. Overall, the role of beneficial microbes in reducing the risk of UTI and other urological diseases, such as urolithiasis, remains a target for researchers. The aim of this perspective is to offer a viewpoint on the status of this approach and recommendations for how to develop novel probiotic therapies.
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Affiliation(s)
- Gregor Reid
- Canadian R&D Centre for Human Microbiome and Probiotics, Lawson Health Research Institute, London, Ontario N6A 4V2, Canada
- Departments of Microbiology and Immunology, and Surgery, Western University, London, Ontario N6A 3K7, Canada
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3
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Li S, Ma C, Yang Y, Cai W, Dai W, Zhang X, Yin L, Tang D, Liu F, Dai Y. Microbiome and metabolome analysis to clarify the interaction between the urine microbiota and serum metabolites in Chinese patients with immunoglobulin A nephropathy. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:1230. [PMID: 36544661 PMCID: PMC9761118 DOI: 10.21037/atm-22-5334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 11/11/2022] [Indexed: 11/30/2022]
Abstract
Background The bacterial and metabolic networks in immunoglobin A nephropathy (IgAN), the most common type of primary chronic glomerulonephritis worldwide, have not been extensively studied. To help develop better methods for the diagnosis, treatment, and prognosis of IgAN, we characterized the alterations of the urinary microbiome and serum metabolome in patients with IgAN. Methods We analyzed serum and urine samples from Chinese patients with IgAN and healthy controls (HCs) using liquid chromatography-tandem mass spectrometry (LC-MS/MS) and 16S ribosomal RNA gene sequencing. Results Patients with IgAN had a higher relative abundance of Actinomyces and a lower relative abundance of Lactobacillus. The elements of metabolism have been affected, including free amino acids, polyunsaturated fatty acids, and oligopeptides. We also identified the 9 metabolites that might be the core metabolites, including guanidinoacetic acid, apo-[3-methylcrotonoyl-CoA:carbon-dioxide ligase (ADP-forming)], and diethanolamine, which linked the metabolic networks between the urinary tract (UT) and blood. Other core metabolites, such as homocitrulline, apo-[3-methylcrotonoyl-CoA:carbon-dioxide ligase (ADP-forming)], butyrylcarnitine, formiminoglutamic acid (FIGLU), diethanolamine, and prolylhydroxyproline, were positively correlated with urinary mili-total protein (MTP). Conversely, Lactobacillus was negatively correlated with MTP. Conclusions We verified the connection between the disruption of the microbiota and serum metabolites, along with the clinical parameters, in patients with IgAN, which may help provide a tool for IgAN interventions.
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Affiliation(s)
- Shishi Li
- Department of Nephrology, The First Affiliated Hospital of Jinan University, Guangzhou, China;,Clinical Medical Research Center, The Second Clinical Medical College of Jinan University, Shenzhen, China
| | - Chiyu Ma
- Clinical Medical Research Center, The Second Clinical Medical College of Jinan University, Shenzhen, China
| | - Yan Yang
- Department of Nephrology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Wanxia Cai
- Clinical Medical Research Center, The Second Clinical Medical College of Jinan University, Shenzhen, China
| | - Weier Dai
- College of Natural Science, The University of Texas at Austin, Austin, TX, USA
| | - Xinzhou Zhang
- Department of Nephrology, The Second Clinical Medical College of Jinan University, Shenzhen, China
| | - Lianghong Yin
- Department of Nephrology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Donge Tang
- Clinical Medical Research Center, The Second Clinical Medical College of Jinan University, Shenzhen, China
| | - Fanna Liu
- Department of Nephrology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Yong Dai
- Clinical Medical Research Center, The Second Clinical Medical College of Jinan University, Shenzhen, China
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4
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Parker E, Cain BN, Hajian B, Ulrich RJ, Geddes EJ, Barkho S, Lee HY, Williams JD, Raynor M, Caridha D, Zaino A, Shekhar M, Muñoz KA, Rzasa KM, Temple ER, Hunt D, Jin X, Vuong C, Pannone K, Kelly AM, Mulligan MP, Lee KK, Lau GW, Hung DT, Hergenrother PJ. An Iterative Approach Guides Discovery of the FabI Inhibitor Fabimycin, a Late-Stage Antibiotic Candidate with In Vivo Efficacy against Drug-Resistant Gram-Negative Infections. ACS CENTRAL SCIENCE 2022; 8:1145-1158. [PMID: 36032774 PMCID: PMC9413440 DOI: 10.1021/acscentsci.2c00598] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Indexed: 05/13/2023]
Abstract
Genomic studies and experiments with permeability-deficient strains have revealed a variety of biological targets that can be engaged to kill Gram-negative bacteria. However, the formidable outer membrane and promiscuous efflux pumps of these pathogens prevent many candidate antibiotics from reaching these targets. One such promising target is the enzyme FabI, which catalyzes the rate-determining step in bacterial fatty acid biosynthesis. Notably, FabI inhibitors have advanced to clinical trials for Staphylococcus aureus infections but not for infections caused by Gram-negative bacteria. Here, we synthesize a suite of FabI inhibitors whose structures fit permeation rules for Gram-negative bacteria and leverage activity against a challenging panel of Gram-negative clinical isolates as a filter for advancement. The compound to emerge, called fabimycin, has impressive activity against >200 clinical isolates of Escherichia coli, Klebsiella pneumoniae, and Acinetobacter baumannii, and does not kill commensal bacteria. X-ray structures of fabimycin in complex with FabI provide molecular insights into the inhibition. Fabimycin demonstrates activity in multiple mouse models of infection caused by Gram-negative bacteria, including a challenging urinary tract infection model. Fabimycin has translational promise, and its discovery provides additional evidence that antibiotics can be systematically modified to accumulate in Gram-negative bacteria and kill these problematic pathogens.
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Affiliation(s)
- Erica
N. Parker
- Department
of Chemistry and Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana−Champaign, Urbana, Illinois 61801, United States
| | - Brett N. Cain
- Department
of Chemistry and Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana−Champaign, Urbana, Illinois 61801, United States
| | - Behnoush Hajian
- Broad
Institute of MIT and Harvard, Cambridge, Massachusetts 02142, United States
| | - Rebecca J. Ulrich
- Department
of Chemistry and Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana−Champaign, Urbana, Illinois 61801, United States
| | - Emily J. Geddes
- Department
of Chemistry and Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana−Champaign, Urbana, Illinois 61801, United States
| | - Sulyman Barkho
- Broad
Institute of MIT and Harvard, Cambridge, Massachusetts 02142, United States
| | - Hyang Yeon Lee
- Department
of Chemistry and Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana−Champaign, Urbana, Illinois 61801, United States
| | - John D. Williams
- Walter
Reed Army Institute of Research, Silver Spring, Maryland 20910 United States
| | - Malik Raynor
- Walter
Reed Army Institute of Research, Silver Spring, Maryland 20910 United States
| | - Diana Caridha
- Walter
Reed Army Institute of Research, Silver Spring, Maryland 20910 United States
| | - Angela Zaino
- Broad
Institute of MIT and Harvard, Cambridge, Massachusetts 02142, United States
| | - Mrinal Shekhar
- Broad
Institute of MIT and Harvard, Cambridge, Massachusetts 02142, United States
| | - Kristen A. Muñoz
- Department
of Chemistry and Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana−Champaign, Urbana, Illinois 61801, United States
| | - Kara M. Rzasa
- Broad
Institute of MIT and Harvard, Cambridge, Massachusetts 02142, United States
| | - Emily R. Temple
- Broad
Institute of MIT and Harvard, Cambridge, Massachusetts 02142, United States
| | - Diana Hunt
- Broad
Institute of MIT and Harvard, Cambridge, Massachusetts 02142, United States
- Department
of Molecular Biology and Center for Computational and Integrative
Biology, Massachusetts General Hospital, Boston, Massachusetts 02115, United States
| | - Xiannu Jin
- Walter
Reed Army Institute of Research, Silver Spring, Maryland 20910 United States
| | - Chau Vuong
- Walter
Reed Army Institute of Research, Silver Spring, Maryland 20910 United States
| | - Kristina Pannone
- Walter
Reed Army Institute of Research, Silver Spring, Maryland 20910 United States
| | - Aya M. Kelly
- Department
of Chemistry and Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana−Champaign, Urbana, Illinois 61801, United States
| | - Michael P. Mulligan
- Department
of Chemistry and Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana−Champaign, Urbana, Illinois 61801, United States
| | - Katie K. Lee
- Broad
Institute of MIT and Harvard, Cambridge, Massachusetts 02142, United States
| | - Gee W. Lau
- Department
of Pathobiology, College of Veterinary Medicine, University of Illinois at Urbana−Champaign, Urbana, Illinois 61801, United States
| | - Deborah T. Hung
- Broad
Institute of MIT and Harvard, Cambridge, Massachusetts 02142, United States
- Department
of Molecular Biology and Center for Computational and Integrative
Biology, Massachusetts General Hospital, Boston, Massachusetts 02115, United States
| | - Paul J. Hergenrother
- Department
of Chemistry and Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana−Champaign, Urbana, Illinois 61801, United States
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5
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He R, Li P, Wang J, Cui B, Zhang F, Zhao F. The interplay of gut microbiota between donors and recipients determines the efficacy of fecal microbiota transplantation. Gut Microbes 2022; 14:2100197. [PMID: 35854629 PMCID: PMC9302524 DOI: 10.1080/19490976.2022.2100197] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Fecal microbiota transplantation (FMT) is a promising treatment for microbiota dysbiosis associated diseases, such as Clostridioides difficile infection (CDI) and inflammatory bowel disease (IBD). The engraftment of donor bacteria is essential for the effectiveness of FMT, which to some extent depends on the matching of donors and recipients. However, how different types of donor-derived bacteria affect FMT efficacy has not been fully dissected. We recruited two longitudinal IBD cohorts of 103 FMT recipients and further analyzed 1,280 microbiota datasets from 14 public CDI and IBD studies to uncover the effect of donor-derived microbiota in recipients. We found that two enterotypes, RCPT/E and RCPT/B (dominated by Enterobacteriaceae and Bacteroides, respectively), consistently exist in both CDI and IBD patients. Based on a time-course-based multi-cohort analysis of FMT fecal samples, we observed the interplay between recipient and donor-derived microbiota during FMT, in which the FMT outcome was significantly associated with the enterotype and microbiota distance between donor and recipient after FMT. We proposed a new measurement, the ratio of colonizers to residents after FMT (C2R), to quantify the engraftment of donor-derived bacteria in the recipients, and then constructed an enterotype-based statistical model for donor-recipient matching, which was validated by both cross-validation and an additional IBD FMT cohort (n = 42). We believe that with the accumulation of FMT multi-omics datasets, machine learning-based methods will be helpful for rational donor selection for improving efficacy and precision FMT practices.
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Affiliation(s)
- Ruiqiao He
- Beijing Institutes of Life Science, Chinese Academy of Sciences, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Pan Li
- Medical Center for Digestive Diseases, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- Key Laboratory of Holistic Integrative Enterology, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jinfeng Wang
- Beijing Institutes of Life Science, Chinese Academy of Sciences, Beijing, China
| | - Bota Cui
- Medical Center for Digestive Diseases, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- Key Laboratory of Holistic Integrative Enterology, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Faming Zhang
- Medical Center for Digestive Diseases, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- Key Laboratory of Holistic Integrative Enterology, Nanjing Medical University, Nanjing, Jiangsu, China
- CONTACT Faming Zhang Key Laboratory of Holistic Integrative Enterology, Nanjing Medical University, Nanjing, Jiangsu210011, China
| | - Fangqing Zhao
- Beijing Institutes of Life Science, Chinese Academy of Sciences, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
- Center for Excellence in Animal Evolution and Genetics, Chinese Academy of Sciences, Kunming, China
- Key Laboratory of Systems Biology, Hangzhou Institute for Advanced Study, University of Chinese Academy of Sciences, Hangzhou, Zhejiang, China
- Fangqing Zhao Beijing Institutes of Life Science, Beijing Institutes of Life Science, Beijing, China
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6
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Van Zyl KN, Matukane SR, Hamman BL, Whitelaw AC, Newton-Foot M. The effect of antibiotics on the human microbiome: a systematic review. Int J Antimicrob Agents 2021; 59:106502. [DOI: 10.1016/j.ijantimicag.2021.106502] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 12/01/2021] [Accepted: 12/11/2021] [Indexed: 12/01/2022]
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7
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Dubourg G, Morand A, Mekhalif F, Godefroy R, Corthier A, Yacouba A, Diakite A, Cornu F, Cresci M, Brahimi S, Caputo A, Lechevallier E, Tsimaratos M, Moal V, Lagier JC, Raoult D. Deciphering the Urinary Microbiota Repertoire by Culturomics Reveals Mostly Anaerobic Bacteria From the Gut. Front Microbiol 2020; 11:513305. [PMID: 33178140 PMCID: PMC7596177 DOI: 10.3389/fmicb.2020.513305] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 09/10/2020] [Indexed: 12/31/2022] Open
Abstract
Human urine was considered sterile for a long time. However, 416 species have been previously cultured, including only 40 anaerobic species. Here, we used culturomics, particularly those targeting anaerobes, to better understand the urinary microbiota. By testing 435 urine samples, we isolated 450 different bacterial species, including 256 never described in urine of which 18 were new species. Among the bacterial species identified, 161 were anaerobes (35%). This study increased the known urine repertoire by 39%. Among the 672 bacterial species isolated now at least once from urine microbiota, 431 (64.1%) were previously isolated from gut microbiota, while only 213 (31.7%) were previously isolated from vagina. These results suggest that many members of the microbiota in the urinary tract are in fact derived from the gut, and a paradigm shift is thus needed in our understanding.
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Affiliation(s)
- Grégory Dubourg
- IRD, AP-HM, Microbes, Evolution, Phylogeny and Infection (MEPHI), IHU Méditerranée Infection, Aix-Marseille University, Marseille, France
| | - Aurélie Morand
- IRD, AP-HM, Microbes, Evolution, Phylogeny and Infection (MEPHI), IHU Méditerranée Infection, Aix-Marseille University, Marseille, France.,Pédiatrie Spécialisée et Médecine Infantile, Hôpital de la Timone, AP-HM, Marseille, France
| | - Fatima Mekhalif
- IRD, AP-HM, Microbes, Evolution, Phylogeny and Infection (MEPHI), IHU Méditerranée Infection, Aix-Marseille University, Marseille, France.,Fondation Méditerranée Infection, Marseille, France
| | - Raphael Godefroy
- IRD, AP-HM, Microbes, Evolution, Phylogeny and Infection (MEPHI), IHU Méditerranée Infection, Aix-Marseille University, Marseille, France.,Fondation Méditerranée Infection, Marseille, France
| | - Alice Corthier
- IRD, AP-HM, Microbes, Evolution, Phylogeny and Infection (MEPHI), IHU Méditerranée Infection, Aix-Marseille University, Marseille, France.,Fondation Méditerranée Infection, Marseille, France
| | - Abdourahamane Yacouba
- IRD, AP-HM, Microbes, Evolution, Phylogeny and Infection (MEPHI), IHU Méditerranée Infection, Aix-Marseille University, Marseille, France.,Fondation Méditerranée Infection, Marseille, France
| | - Ami Diakite
- IRD, AP-HM, Microbes, Evolution, Phylogeny and Infection (MEPHI), IHU Méditerranée Infection, Aix-Marseille University, Marseille, France.,Fondation Méditerranée Infection, Marseille, France
| | - Florent Cornu
- IRD, AP-HM, Microbes, Evolution, Phylogeny and Infection (MEPHI), IHU Méditerranée Infection, Aix-Marseille University, Marseille, France
| | - Marina Cresci
- IRD, AP-HM, Microbes, Evolution, Phylogeny and Infection (MEPHI), IHU Méditerranée Infection, Aix-Marseille University, Marseille, France
| | - Samy Brahimi
- IRD, AP-HM, Microbes, Evolution, Phylogeny and Infection (MEPHI), IHU Méditerranée Infection, Aix-Marseille University, Marseille, France.,Fondation Méditerranée Infection, Marseille, France
| | - Aurélia Caputo
- IRD, AP-HM, Microbes, Evolution, Phylogeny and Infection (MEPHI), IHU Méditerranée Infection, Aix-Marseille University, Marseille, France
| | - Eric Lechevallier
- Department of Urology and Renal Transplantation, La Conception University Hospital, AP-HM, Aix-Marseille University, Marseille, France
| | - Michel Tsimaratos
- Pédiatrie Multidisciplinaire, Hôpital de la Timone, AP-HM, Marseille, France
| | - Valérie Moal
- IRD, AP-HM, Microbes, Evolution, Phylogeny and Infection (MEPHI), IHU Méditerranée Infection, Aix-Marseille University, Marseille, France.,Centre de Nephrologie et Transplantation Rénale, Hôpital de la Conception, Aix-Marseille University, Marseille, France
| | - Jean-Christophe Lagier
- IRD, AP-HM, Microbes, Evolution, Phylogeny and Infection (MEPHI), IHU Méditerranée Infection, Aix-Marseille University, Marseille, France
| | - Didier Raoult
- IRD, AP-HM, Microbes, Evolution, Phylogeny and Infection (MEPHI), IHU Méditerranée Infection, Aix-Marseille University, Marseille, France
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8
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Steed DB, Wang T, Raheja D, Waldman AD, Babiker A, Dhere T, Kraft CS, Woodworth MH. Gram-Negative Taxa and Antimicrobial Susceptibility after Fecal Microbiota Transplantation for Recurrent Clostridioides difficile Infection. mSphere 2020; 5:e00853-20. [PMID: 33055258 PMCID: PMC7565895 DOI: 10.1128/msphere.00853-20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 09/20/2020] [Indexed: 12/15/2022] Open
Abstract
Fecal microbiota transplantation (FMT) has promising applications in reducing multidrug-resistant organism (MDRO) colonization and antibiotic resistance (AR) gene abundance. However, data on clinical microbiology results after FMT are limited. We examined the changes in antimicrobial susceptibility profiles in patients with Gram-negative infections in the year before and the year after treatment with FMT for recurrent Clostridioides difficile infection (RCDI). We also examined whether a history of FMT changed health care provider behavior with respect to culture ordering and antibiotic prescription. Medical records for RCDI patients who underwent FMT at Emory University between July 2012 and March 2017 were reviewed retrospectively. FMT-treated patients with Gram-negative culture data in the 1-year period preceding and the 1-year period following FMT were included. Demographic and clinical data were abstracted, including CDI history, frequency of Gram-negative cultures, microbiological results, and antibiotic prescription in response to positive cultures in the period following FMT. Twelve patients were included in this case series. We pooled data from infections at all body sites and found a decrease in the number of total and Gram-negative cultures post-FMT. We compared susceptibility profiles across taxa given the potential for horizontal transmission of AR elements and observed increased susceptibility to nitrofurantoin, trimethoprim-sulfamethoxazole, and the aminoglycosides. FMT did not drastically influence health care provider ordering of bacterial cultures or antibiotic prescribing practices. We observed a reduction in Gram-negative cultures and a trend toward increased antimicrobial susceptibility. This study supports further investigation of FMT as a means of improving antimicrobial susceptibility.IMPORTANCE Fecal microbiota transplantation (FMT), which is highly efficacious in treating recurrent C. difficile infection (RCDI), has a promising application in decolonization of multidrug-resistant organisms, reduction of antibiotic resistance gene abundance, and restoration of healthy intestinal microbiota. However, data representing clinical microbiology results after FMT are limited. We sought to characterize the differences in culture positivity and antimicrobial susceptibility profiles in patients with Gram-negative infections in the year before and the year after FMT for RCDI. Drawing on prior studies that had demonstrated the success of FMT in eradicating extraintestinal infections and the occurrence of patient-level interspecies transfer of resistance elements, we employed an agnostic analytic approach of reviewing the data irrespective of body site or species. In a small RCDI population, we observed an improvement in the antimicrobial susceptibility profile of Gram-negative bacteria following FMT, which supports further study of FMT as a strategy to combat antibiotic resistance.
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Affiliation(s)
| | - Tiffany Wang
- Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Alex D Waldman
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ahmed Babiker
- Emory University School of Medicine, Department of Pathology and Laboratory Medicine, Atlanta, Georgia, USA
| | - Tanvi Dhere
- Emory University School of Medicine, Department of Medicine, Division of Digestive Diseases, Atlanta, Georgia, USA
| | - Colleen S Kraft
- Emory University School of Medicine, Department of Pathology and Laboratory Medicine, Atlanta, Georgia, USA
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, Georgia, USA
| | - Michael H Woodworth
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, Georgia, USA
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9
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Abstract
Urosepsis is defined as a severe disease due to organ failure caused by a urinary tract infection. An empirical antibiotic therapy should be instigated within the first hour after diagnosis. Urine cultures and blood cultures should be performed before antibiotic treatment. Further diagnostics should be carried out at an early stage to enable an interventional focus control in the case of urinary tract obstruction or abscess formation, if necessary. Gram-negative pathogens are most frequently isolated. Extended spectrum beta-lactamase (ESBL) forming bacteria as a cause of urosepsis are increasing. Carbapenemase-forming Enterobacteriaceae, on the other hand, are still rare. The empirical treatment consists of a broad spectrum beta-lactam antibiotic. While piperacillin/tazobactam, carbapenems and the new cephalosporin/beta-lactamase inhibitor (BLI) combinations are given as monotherapy, cephalosporins should be combined with aminoglycosides (preferred) or fluoroquinolones. If a combination therapy is given, it should be de-escalated to a monotherapy after 48-72 h.
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Affiliation(s)
- Mathias W Pletz
- Zentrum für Infektionsmedizin und Krankenhaushygiene, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland.,Center for Sepsis Control and Care, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland
| | - Sebastian Weis
- Zentrum für Infektionsmedizin und Krankenhaushygiene, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland.,Center for Sepsis Control and Care, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland.,Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland
| | - Christina Forstner
- Zentrum für Infektionsmedizin und Krankenhaushygiene, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland.,Klinische Abteilung für Infektionen und Tropenmedizin, Universitätsklinik für Innere Medizin I, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Florian Wagenlehner
- Klinik und Poliklinik für Urologie, Kinderurologie und Andrologie, Justus-Liebig-Universität Gießen, Rudolf-Buchheim-Str. 7, 35392, Gießen, Deutschland.
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10
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Abstract
Urosepsis is defined as a severe disease due to organ failure caused by a urinary tract infection. An empirical antibiotic therapy should be instigated within the first hour after diagnosis. Urine cultures and blood cultures should be performed before antibiotic treatment. Further diagnostics should be carried out at an early stage to enable an interventional focus control in the case of urinary tract obstruction or abscess formation, if necessary. Gram-negative pathogens are most frequently isolated. Extended spectrum beta-lactamase (ESBL) forming bacteria as a cause of urosepsis are increasing. Carbapenemase-forming Enterobacteriaceae, on the other hand, are still rare. The empirical treatment consists of a broad spectrum beta-lactam antibiotic. While piperacillin/tazobactam, carbapenems and the new cephalosporin/beta-lactamase inhibitor (BLI) combinations are given as monotherapy, cephalosporins should be combined with aminoglycosides (preferred) or fluoroquinolones. If a combination therapy is given, it should be de-escalated to a monotherapy after 48-72 h.
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Durán L. Resistencia antimicrobiana e implicancias para el manejo de infecciones del tracto urinario. REVISTA MÉDICA CLÍNICA LAS CONDES 2018. [DOI: 10.1016/j.rmclc.2018.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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