Fecal microbiota transplantation against intestinal Extended Spec­trum beta-Lactamase producing Enterobacteriaceae coloni­za­tion in renal transplant and non-transplant patients

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R. Singh, S.E. Geerlings, P.F. de Groot, M. Nieuwdorp, C.J. Hodiamont, R.J.M ten Berge, F.J. Bemelman

Chair(s): dr. Dennis A. Hesselink, internist-nefroloog, Erasmus MC & dr. Marieke Roemeling, internist i.o., UMC Groningen

Wednesday 9 march 2016

16:30 - 16:40h at Zaal 1 & 2

Categories: Parallelsessie (klinisch)

Parallel session: Parallelsessie V - Klinisch

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Introduction:
Infections by Extended Spectrum beta-Lactamase (ESBL) producing Enterobacteriaceae is causing significant morbidity among patients resulting in frequent hospitlizations and the need of longstanding intravenous antibiotic use. Patients with recurrent antibiotic exposure and renal transplant patients are at risk for colonization by ESBL producing Enterobacteriaceae. Van Nood et.al. (New England Journal of Medicine 2013) demonstrated that fecal microbiota transplantation (FMT) is highly effective against Clostridium difficile colitis with overall success rate of 94%. AIMS: To evaluate the effectiveness of FMT against intestinal colonization by ESBL producing Enterobacteriaceae.

Methods:
We performed a proof of principle study in renal transplant and non-transplant patients with intestinal colonization by ESBL producing Enterobacteriaceae confirmed by rectal swab culture. These patients underwent FMT with feces of a healthy donor, administered through a nasoduodenal tube. All patients underwent full colon lavage with cetomacrogol one day prior to FMT. Follow-up after FMT consisted of rectal culture on ESBL taken at week 1, 2, 4 and 12 after FMT. If the ESBL producing Enterobacteriaceae still persisted, a second FMT was performed.

Results:
In total, 4 renal transplant and 11 non-transplant patients with intestinal ESBL producing Enterobacteriaceae colonization underwent FMT. In the renal transplant group: 1 renal transplant patient was successfully decolonized after the first FMT whereas another after a second FMT. The other two are still in follow-up. In the non-transplant group (n=11); 2 patients (18.2%) were decolonized after the first FMT and another 2 (18.2%) after the two FMT procedures. ESBL persistence occurred in 5 non-transplant patients (45.4%) whereas two patients (18.2%) are still in follow-up. Two patients have more than a year follow-up after successful decolonization after FMT; these two remained ESBL-free. Side effects: 4 out of 15 patients (26.7%) reported self-limiting mild abdominal cramps during FMT. No nausea or vomiting occurred.

Conclusion:
FMT to eradicate ESBL producing Enterobacteriaceae seems to be less efficacious than FMT to treat Clostridium difficile and has an overall success rate of 40%.