Intestinal microbiota and antibiotic resistance: Perspectives and solutions

Climent Casals-Pascual,Andrea Vergara,Jordi Vila

doi:10.1016/j.humic.2018.05.002

Climent Casals-Pascual, Andrea Vergara + Show 1 more

Open Access

https://doi.org/10.1016/j.humic.2018.05.002

Copy DOI

Abstract

The intestinal commensal microbiota provides a myriad of benefits to the healthy host, including colonisation resistance against pathogens. Perturbations of the intestinal microbiota (dysbiosis) may adversely affect the health status of an individual and prevent protection against colonisation. The whole range of antibiotic resistance genes (resistome) in a specific microbiota is found in pathogenic and non-pathogenic bacteria. The administration of antibiotics may cause dysbiosis, contributing to the loss of colonisation resistance followed by an increment of the resistome in the intestinal microbiota. Treatments to control the current increase of multi drug-resistant (MDR) bacteria are extremely limited. In this context, the administration of healthy faecal microbiota to restore colonisation resistance and displace MDR bacteria emerges as a promising therapeutic alternative.This brief review describes the role of the intestinal microbiota as a reservoir of MDR bacteria, the impact of different groups of antibiotics in the selection of MDR bacteria and crucially, the potential use of faecal microbiota transplantation using “healthy” or “MDR-free microbiota” to displace MDR bacteria and restore colonisation resistance.

Highlights

The intestinal microbiota constitutes a diverse ecosystem that contains thousands of different microbial species [1]
This observation together with evidence from animal models suggesting that vancomycinresistant Enterococcus spp. (VRE) and carbapenem-resistant Enterobacteriaceae (CRE) can be eliminated following faecal microbiota transplant (FMT) supports the clinical potential for this procedure to control the resistome
The majority of these reports are observational studies resulting from patients treated for recurrent C. difficile infection (CDI) who were known to be colonised with multi drug-resistant (MDR) bacteria which disappear after FMT was conducted

Summary

Introduction

The intestinal microbiota constitutes a diverse ecosystem that contains thousands of different microbial species [1]. Indirect evidence from studies evaluating the clinical efficacy of FMT in CDI has shown that the mean number of antibiotic-resistance genes of 34.5 ( ± 6.7) prior to FMT significantly decreased to 12.2 ( ± 7.0), 1 to 3 weeks after FMT This observation together with evidence from animal models suggesting that VRE and CRE can be eliminated following FMT supports the clinical potential for this procedure to control the resistome. Since 2014, 21 studies with a total of 111 patients have been published to address the potential use of FMT to eliminate antibiotic-resistant microorganisms, mainly CRE, ESBL-E and VRE (Table 1) The majority of these reports are observational studies resulting from patients treated for recurrent CDI who were known to be colonised with MDR bacteria which disappear after FMT was conducted.

Results

Conflict of interest

Conclusions