Decolonization of multi-drug resistant bacteria by fecal microbiota transplantation in five pediatric patients before allogeneic hematopoietic stem cell transplantation: gut microbiota profiling, infectious and clinical outcomes

摘要

Fecal microbiota transplantation (FMT) is playing a prominent role in the treatment of recurrent Clostridium difficile infection in adults, showing high efficacy and safety.1 It has also been proposed for treatment of other diseases associated with alterations of intestinal microbiota, including intestinal inflammatory diseases (inflammatory bowel disease)2 and graft-versus-host disease (GvHD).3 Moreover, FMT has been proposed for decolonization of multi-drug resistant (MDR) germs from the intestinal tract, with good results in adults.4,5 Indeed, antimicrobial resistance (AMR) is of great concern in the hemato-oncologic field, since a very high mortality rate has been demonstrated in patients infected by MDR bacteria (up to 36-95% in patients undergoing allogeneic hematopoietic stem cell transplantation [HSCT]).6 Moreover, up to 70% of cases of bacteremia originate from the gut in these patients.