Abstract
BackgroundColonisation 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. ObjectivesThis 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 colonisation. MethodA 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. ResultsAt 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 microbiota 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). ConclusionFaecal 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.
Highlights
Since the first description of a plasmidic Enterobacteriaceae carbapenemase, Klebsiella pneumoniae (K. pneumoniae) carbapenemase (KPC) in the USA [1], a wide variety of plasmid-borne resistance mechanisms have been described, mainly through metalloenzymes such as New Delhi Metallo-beta-lactamase (NDM) or oxacillinases type OXA-48-like carbapenemases
The current study aimed to evaluate the impact of Faecal microbiota transplantation (FMT) on the delay of digestive decolonisation in long-term carbapenemase-producing Enterobacteriacae (CPE)/A-colonised patients, for whom transfer to a specialised medical care unit was compromised
The study reviewed medical records and laboratory data on FMTs performed between January 14, 2015 and October 20, 2017 in patients whose digestive tracts were colonised by carbapenemase-producing Enterobacteriaceae or Acinetobacter (CPE/A), and who were admitted to the institution for initial clustering and decolonisation purpose
Summary
Since the first description of a plasmidic Enterobacteriaceae carbapenemase, Klebsiella pneumoniae (K. pneumoniae) carbapenemase (KPC) in the USA [1], a wide variety of plasmid-borne resistance mechanisms have been described, mainly through metalloenzymes such as New Delhi Metallo-beta-lactamase (NDM) or oxacillinases type OXA-48-like carbapenemases. The estimated cost of a CPE outbreak has been evaluated at $474 474 according to Gagnaire et al [9] (2-months outbreak in Saint-Etienne, France) and €100 000 per month according to Semin-Pelletier et al (2-months outbreak in Nantes, France) [10] Such colonisation has resulted in a significant increase (almost double) in the length of hospital stays [11,12], delay in optimal medical care, and loss of medical opportunities [13]. 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. 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 colonisation. A standardised protocol, including 5 days of antibiotic treatment, bowel cleansing and systematic indwelling devices removal, should improve protocol effectiveness
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