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Abstract
Antibiotics have benefitted human health since their introduction nearly a century ago. However, the rise of antibiotic resistance may portend the dawn of the "post-antibiotic age." With the narrow pipeline for novel antimicrobials, we need new approaches to deal with the rise of multidrug resistant organisms. In the last 2 decades, the role of the intestinal microbiota in human health has been acknowledged and studied widely. Of the various activities carried out by the gut microbiota, colonization resistance is a key function that helps maintain homeostasis. Therefore, re-establishing a healthy microbiota is a novel strategy for treating drug resistance organisms. Preliminary studies suggest that this is a viable approach. However, the extent of their success still needs to be examined. Herein, we will review work in this area and suggest where future studies can further investigate this method for dealing with the threat of antibiotic resistance.
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Affiliation(s)
- Nguyen T Q Nhu
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Vincent B Young
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, Michigan, USA
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Salandre A, Delannoy J, Goudiaby MTB, Barbut F, Thomas M, Waligora-Dupriet AJ, Kapel N. A Simple In Vitro Test to Select Stools for Fecal Microbiota Transplantation to Limit Intestinal Carriage of Extensively Drug-Resistant Bacteria. Microorganisms 2023; 11:2753. [PMID: 38004765 PMCID: PMC10673217 DOI: 10.3390/microorganisms11112753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/02/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023] Open
Abstract
Treatment options for multidrug-resistant bacterial infections are limited and often ineffective. Fecal microbiota transplantation (FMT) has emerged as a promising therapy for intestinal multidrug-resistant bacterial decolonization. However, clinical results are discrepant. The aim of our pilot study was to evaluate the screening performance of a simple diagnostic tool to select fecal samples that will be effective in decolonizing the intestine. Fecal samples from 10 healthy subjects were selected. We developed an agar spot test to evaluate their antagonistic activity toward the growth of VanA Enterococcus faecium and OXA-48-producing Klebsiella pneumoniae, two of the most serious and urgent threats of antibiotic resistance. Most fecal samples were able to limit the growth of both bacteria in vitro but with large inter-individual variation. The samples with the highest and lowest antagonistic activity were used for FMT in a mouse model of intestinal colonization. FMT was not successful in reducing intestinal colonization with VanA Enterococcus faecium, whereas FMT performed with the fecal sample showing the highest activity on the agar spot test was able to significantly reduce the intestinal colonization of mice with Klebsiella pneumoniae OXA-48. The agar spot test could thus serve as a reliable screening tool to select stool samples with the best potential to eradicate/reduce multidrug-resistant bacteria carriage after FMT.
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Affiliation(s)
- Angélique Salandre
- INSERM UMR-S1139, Faculty of Pharmacy, Université Paris Cité, F-75006 Paris, France; (A.S.); (J.D.); (M.T.B.G.); (F.B.); (A.-J.W.-D.)
| | - Johanne Delannoy
- INSERM UMR-S1139, Faculty of Pharmacy, Université Paris Cité, F-75006 Paris, France; (A.S.); (J.D.); (M.T.B.G.); (F.B.); (A.-J.W.-D.)
| | - Marie Thérèse Barba Goudiaby
- INSERM UMR-S1139, Faculty of Pharmacy, Université Paris Cité, F-75006 Paris, France; (A.S.); (J.D.); (M.T.B.G.); (F.B.); (A.-J.W.-D.)
| | - Frédéric Barbut
- INSERM UMR-S1139, Faculty of Pharmacy, Université Paris Cité, F-75006 Paris, France; (A.S.); (J.D.); (M.T.B.G.); (F.B.); (A.-J.W.-D.)
- Infection Control Unit, APHP, Saint-Antoine Hospital, F-75012 Paris, France
- Paris Center for Microbiome Medicine (PaCeMM), Fédération Hospitalo-Universitaire, F-75011 Paris, France;
| | - Muriel Thomas
- Paris Center for Microbiome Medicine (PaCeMM), Fédération Hospitalo-Universitaire, F-75011 Paris, France;
- Micalis Institute, AgroParisTech, INRAE, Université Paris-Saclay, F-78350 Jouy-en-Josas, France
| | - Anne-Judith Waligora-Dupriet
- INSERM UMR-S1139, Faculty of Pharmacy, Université Paris Cité, F-75006 Paris, France; (A.S.); (J.D.); (M.T.B.G.); (F.B.); (A.-J.W.-D.)
- Paris Center for Microbiome Medicine (PaCeMM), Fédération Hospitalo-Universitaire, F-75011 Paris, France;
| | - Nathalie Kapel
- INSERM UMR-S1139, Faculty of Pharmacy, Université Paris Cité, F-75006 Paris, France; (A.S.); (J.D.); (M.T.B.G.); (F.B.); (A.-J.W.-D.)
- Paris Center for Microbiome Medicine (PaCeMM), Fédération Hospitalo-Universitaire, F-75011 Paris, France;
- Department of Coprology, APHP, Pitié-Salpêtrière Hospital, F-75013 Paris, France
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Intestinal colonization with multidrug-resistant Enterobacterales: screening, epidemiology, clinical impact, and strategies to decolonize carriers. Eur J Clin Microbiol Infect Dis 2023; 42:229-254. [PMID: 36680641 PMCID: PMC9899200 DOI: 10.1007/s10096-023-04548-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 01/11/2023] [Indexed: 01/22/2023]
Abstract
The clinical impact of infections due to extended-spectrum β-lactamase (ESBL)- and/or carbapenemase-producing Enterobacterales (Ent) has reached dramatic levels worldwide. Infections due to these multidrug-resistant (MDR) pathogens-especially Escherichia coli and Klebsiella pneumoniae-may originate from a prior asymptomatic intestinal colonization that could also favor transmission to other subjects. It is therefore desirable that gut carriers are rapidly identified to try preventing both the occurrence of serious endogenous infections and potential transmission. Together with the infection prevention and control countermeasures, any strategy capable of effectively eradicating the MDR-Ent from the intestinal tract would be desirable. In this narrative review, we present a summary of the different aspects linked to the intestinal colonization due to MDR-Ent. In particular, culture- and molecular-based screening techniques to identify carriers, data on prevalence and risk factors in different populations, clinical impact, length of colonization, and contribution to transmission in various settings will be overviewed. We will also discuss the standard strategies (selective digestive decontamination, fecal microbiota transplant) and those still in development (bacteriophages, probiotics, microcins, and CRISPR-Cas-based) that might be used to decolonize MDR-Ent carriers.
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