Fecal Microbiota Transplantation in Patients With Blood Disorders Inhibits Gut Colonization With Antibiotic-Resistant Bacteria: Results of a Prospective, Single-Center Study

Background

Patients with blood disorders colonized with antibiotic-resistant bacteria (ARB) are prone to systemic infections that are difficult to treat. Reintroduction of commensal bacteria in a murine model of enterococcal colonization of the gut can lead to eradication of enterococci. We hypothesized that fecal microbiota transplantation (FMT) could be used to eradicate ARB in humans.

Methods

Participants colonized with ARB were treated with intraduodenal FMT according to a prospective protocol (NCT02461199). The primary endpoint was complete ARB decolonization at 1 month after FMT. Secondary endpoints included safety assessment and partial ARB decolonization. Microbiome sequencing was performed to investigate the influence of microbial composition of the transplanted material on the outcome of FMT.

Results

Twenty-five FMTs were performed in 20 participants (including 40% who had neutropenia) who were colonized by a median of 2 (range, 1-4) strains of ARB. The primary endpoint was reached in 15/25 (60%) of the FMTs and more frequently in cases in which there was no periprocedural use of antibiotics (79% vs 36%, P < .05). Among participants, 15/20 (75%) experienced complete ARB decolonization. There were no severe adverse events, and partial ARB decolonization was observed in 20/25 (80%) of the FMTs. The microbiota composition analysis revealed higher abundance of Barnesiella spp., Bacteroides, and Butyricimonas and greater bacterial richness in the fecal material, resulting in eradication of Klebsiella pneumoniae compared with nonresponders.

Conclusions

FMT in patients with blood disorders is safe and promotes eradication of ARB from the gastrointestinal tract.

Clinical Trials Registration

NCT02461199.

An analysis of risk factors of Clostridiumdifficile infection in patients hospitalized in the teaching hospital in 2008

The last decade saw an increase in the incidence of Clostridium difficile infections.Approximately 80% of these infections occur in hospitalized patients. There are ongoing studies on the increase in the incidence of infections with this microorganism.

OBJECTIVE

The objective of this study was to assess the risk factors of C. dicfficile infections in patients hospitalized in the teaching hospital in Warsaw in 2008.

MATERIAL AND METHODS

A case-control study was conducted to achieve this objective. The study group comprised 266 patients. Patients in the study group were assessed for the following factors: sex; age; place of residence; hospitalizations; the use of proton pump inhibitors (IPP), various antibiotics, probiotics; hospital stay conditions, and the patient's condition.

RESULTS

The statistical analysis showed that out of the assessed risk factors, hospitalization within the 3 months preceding hospital admission (OR 5.02; P<0.003) and antibiotic therapy (OR 4.85; P<0.003) were associated with the highest risk of C. difficile infection. Hospital stay conditions, including a stay in a multi-bed room (OR 1.64; P=0.05) or in a room without an en suite toilet (OR 1.59; P=0.01), were also shown to play a role. The risk of a C. difficile infection was also increased in the case of "bed-ridden" patients requiring the assistance of hospital staff for their daily hygiene (OR 1.69; P=0.01).

CONCLUSIONS

This study demonstrated that hospitalization itself, including the frequency and conditions of hospital stay, as well as receiving antibiotic therapy were significant risk factors of C. difficile infections in patients hospitalized at the SP CSK. Therefore, our analysis showed that C. difficile infections are mostly nosocomial.

[The use of molecular methods in the diagnosis of Clostridium difficile infections]

INTRODUCTION

The aim of this study was to use molecular methods to identify selected strains of C. difficile isolated from patients hospitalized at Independent Public Central Teaching Hospital [SP CSK] between 2008 and 2011 in order to demonstrate their toxicgenic character and to determine their epidemic potential, including the incidence of a suspected C. difficile strain 027/NAP1/B1.

MATERIAL AND METHODS

Originally evaluated material consisted of freshly collected stool samples from patients who had developed diarrhea. Stool samples were assessed for toxins A and B via an immunoenzymatic method and for the presence of C. difficile via the first culture method. The isolated strains were stored on MICROBANK mediums, at -70 degrees C. From this sample collection, 48 strains isolated in 2008 and 28 strains isolated in 2011 were selected for molecular analysis.

RESULTS

Among the C. difficile isolates that underwent molecular analysis there were 6 strains 027/NAP1/BI out of the 48 evaluated strains isolated in 2008, which constituted 12.5% and 24 strains 027/NAP1/BI out of the 28 strains isolated in 2011, which constituted 85.7%.

CONCLUSIONS

Identification of a possible hyperepidemic strain of C. difficile is crucial for undertaking any anti-epidemic activities in health care facilities, where such activities are more and more common and are responsible for nosocomial foci of infection.

Sequence variation in pertussis S1 subunit toxin and pertussis genes in Bordetella pertussis strains used for the whole-cell pertussis vaccine produced in Poland since 1960: efficiency of the DTwP vaccine-induced immunity against currently circulating B. pertussis isolates

The present study indicates that the appearance of the B. pertussis harbouring prn2 gene allele variant (not found among clinical isolates before 1990s) may have been induced by long-term vaccination in Poland with DTP-composed vaccine strains presenting exclusively prn1. However, ptxS1A allele of pertussis toxin subunit S1 encoding gene, predominant in the currently isolated B. pertussis strains, has been found in vaccine strains used for whole-cell pertussis component (wP) production of DTP vaccine in 1960-1978. This outrules the possibility that the appearance of ptxSIA allele might be related to vaccine pressure driven by non-ptxS1A vaccine strains used for long-term immunization with wP. Intranasal challenge animal model testing the efficiency of the clearance of B. pertussis strains harbouring different ptxS1/prn allele gene combinations revealed that currently produced DTwP vaccine may not contain adequate B. pertussis vaccine strains, since isolates with gene variants different from those observed in vaccine strains were eliminated from the lungs of the immunized animals with lower efficiency.

[Immunity of children aged 6-8 against pertussis, tetanus and diphtheria]

Vaccination against pertussis has been performed since 1960. Whole cell pertussis vaccine produced by Plant of Sera and Vaccines Biomed S.A. in Kraków, has been used. After vaccination has been introduced, epidemiological situation of pertussis in Poland improved, but in 90's the decrease of immunity was observed. The aim of this work was to determine pertussis immunity of children after several years from the last dose of pertussis vaccine. For comparison purposes immunity against tetanus and diphtheria was tested. Protective antibody levels were detected in 70%, 58%, and 45% children aged 6, 7, and 8, respectively. It shows that decrease of immunity may cause increasing number of pertussis in children above 5. Taking into consideration our results, it seems necessary to introduce additional dose of pertussis vaccine among children aged 5 years. The level of tetanus and diphtheria antibodies was high in all tested groups.

Phenotypical and genotypical characterization of Neisseria meningitidis carrier strains isolated from Polish recruits in 1998

The aim of this study was to investigate the Neisseria meningitidis carriage rate among two cohorts of Polish recruits upon entry to the military and during the first 2 months of their service, i.e. in the spring and autumn of 1998, and to characterize the meningococcal strains isolated. Pharyngeal swabs were taken four and five times from 151 and 168 men, respectively. Altogether, 81 and 180 meningococcal isolates representing 54 and 102 different strains were recovered. The overall rates of carriage in the spring and in the autumn were 36% and 61%, and, among recruits who submitted to sampling on at least three occasions, 39% and 55%. Eighty-three of 156 (53%) meningococcal carrier strains were nongroupable; among the remaining strains, serogroup B was predominant (32% of all carrier strains). In both surveys the predominant phenotype was Neisseria meningitidis NG:21:P1.7.

[Tests for Neisseria meningitidis in adolescents and adults (recruits)]

No N. meningitidis strain was isolated from 168 children 14 years old. However, among 17-19 years old young people 14% meningococcal carriage rate was demonstrated. In three surveillance trials performed in military units in spring 1998 and autumn 1998 and 1999; 81, 225 and 153 isolates of N. meningitidis, respectively were obtained. A change in N. meningitidis carrier status was observed. At the autumn study, two times more N. meningitidis intermittent carriers were found than in the spring investigations. Among these population we found short-term and long-term carriers--last day of the longest trial--162 day. Meningococcal carriage rate increases among recruits in overcrowded living conditions.

[The study of carrier of Neisseria meningitidis performed in Zielonec and characteristics of meningogocci isolated from patients at the Wołomin hospital, Warsaw district]

Meningococcal carriage study, performed after N. meningitidis outbreak in Zielonka included 130 persons (111 children). No N. meningitidis strain was isolated. Phenotype and genotype analysis of 6 meningococcal isolates obtained from blood and CSF, showed their heterogeneity with exception of 2 isolates from Zielonka's cases of meningococcal sepsis which were identical.

[Meningococcal infections in Warsaw's district]

The epidemiological situation of meningococcal meningitis in Warsaw's district in comparison to the situation in Poland in the years 1980-1997 in discussed. In September 1997, the local population of Zielonka--small city in Warsaw's district, was alarmed by two meningococcal septicaemia cases in girls attending to the same kindergarten. Anti-epidemic measures undertaken were described.

Simultaneous persistence of methicillin-resistant and methicillin-susceptible clones of Staphylococcus aureus in a neonatal ward of a Warsaw hospital

Fifty-seven methicillin-resistant Staphylococcus aureus (MRSA) isolates from babies (N = 31), carriers amongst health care workers (N = 16; 10% of all staff members) and the environment (N = 10); 39 MSSA isolates, from babies (N = 18), health care workers (N = 5) and environment (N = 16) were analysed. The strains were from the neonatal ward of a teaching hospital in Warsaw and were collected over a period of 16 months (1993/1994). The isolates were characterized by phage-typing, arbitrary-primed polymerase chain reaction (AP PCR), DNA repeat polymorphism within the protein A gene and the resistance pattern to antimicrobial agents. The presence of the mecA gene was determined by PCR. MRSA were classified as heterogeneously resistant to methicillin, susceptible to other antimicrobial agents and, except for three isolates, appeared to be genotypically almost identical. The first example of mupirocin resistant MRSA in Poland was documented. Amongst MSSA isolates, increased variability was seen, however, the persistence of one predominate clone of MSSA was shown. In this particular hospital environment, several different strains of both MRSA and MSSA were capable of maintaining persistent colonization.