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Fecal Microbiota Transplant Mitigates Adverse Outcomes Seen in Patients Colonized With Multidrug-Resistant Organisms Undergoing Allogeneic Hematopoietic Cell Transplantation

The gut microbiome can be adversely affected by chemotherapy and antibiotics prior to hematopoietic cell transplantation (HCT). This affects graft success and increases susceptibility to multidrug-resistant organism (MDRO) colonization and infection. We performed an initial retrospective analysis of...

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Autores principales: Innes, Andrew J., Mullish, Benjamin H., Ghani, Rohma, Szydlo, Richard M., Apperley, Jane F., Olavarria, Eduardo, Palanicawandar, Renuka, Kanfer, Edward J., Milojkovic, Dragana, McDonald, Julie A. K., Brannigan, Eimear T., Thursz, Mark R., Williams, Horace R. T., Davies, Frances J., Marchesi, Julian R., Pavlů, Jiří
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8430254/
https://www.ncbi.nlm.nih.gov/pubmed/34513724
http://dx.doi.org/10.3389/fcimb.2021.684659
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author Innes, Andrew J.
Mullish, Benjamin H.
Ghani, Rohma
Szydlo, Richard M.
Apperley, Jane F.
Olavarria, Eduardo
Palanicawandar, Renuka
Kanfer, Edward J.
Milojkovic, Dragana
McDonald, Julie A. K.
Brannigan, Eimear T.
Thursz, Mark R.
Williams, Horace R. T.
Davies, Frances J.
Marchesi, Julian R.
Pavlů, Jiří
author_facet Innes, Andrew J.
Mullish, Benjamin H.
Ghani, Rohma
Szydlo, Richard M.
Apperley, Jane F.
Olavarria, Eduardo
Palanicawandar, Renuka
Kanfer, Edward J.
Milojkovic, Dragana
McDonald, Julie A. K.
Brannigan, Eimear T.
Thursz, Mark R.
Williams, Horace R. T.
Davies, Frances J.
Marchesi, Julian R.
Pavlů, Jiří
author_sort Innes, Andrew J.
collection PubMed
description The gut microbiome can be adversely affected by chemotherapy and antibiotics prior to hematopoietic cell transplantation (HCT). This affects graft success and increases susceptibility to multidrug-resistant organism (MDRO) colonization and infection. We performed an initial retrospective analysis of our use of fecal microbiota transplantation (FMT) from healthy donors as therapy for MDRO-colonized patients with hematological malignancy. FMT was performed on eight MDRO-colonized patients pre-HCT (FMT-MDRO group), and outcomes compared with 11 MDRO colonized HCT patients from the same period. At 12 months, survival was significantly higher in the FMT-MDRO group (70% versus 36% p = 0.044). Post-HCT, fewer FMT-MDRO patients required intensive care (0% versus 46%, P = 0.045) or experienced fever (0.29 versus 0.11 days, P = 0.027). Intestinal MDRO decolonization occurred in 25% of FMT-MDRO patients versus 11% non-FMT MDRO patients. Despite the significant differences and statistically comparable patient/transplant characteristics, as the sample size was small, a matched-pair analysis between both groups to non-MDRO colonized control cohorts (2:1 matching) was performed. At 12 months, the MDRO group who did not have an FMT had significantly lower survival (36.4% versus 61.9% respectively, p=0.012), and higher non relapse mortality (NRM; 60.2% versus 16.7% respectively, p=0.009) than their paired non-MDRO-colonized cohort. Conversely, there was no difference in survival (70% versus 43.4%, p=0.14) or NRM (12.5% versus 31.2% respectively, p=0.24) between the FMT-MDRO group and their paired non-MDRO cohort. Collectively, these data suggest that negative clinical outcomes, including mortality associated with MDRO colonization, may be ameliorated by pre-HCT FMT, even in the absence of intestinal MDRO decolonization. Further work is needed to explore this observed benefit.
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spelling pubmed-84302542021-09-11 Fecal Microbiota Transplant Mitigates Adverse Outcomes Seen in Patients Colonized With Multidrug-Resistant Organisms Undergoing Allogeneic Hematopoietic Cell Transplantation Innes, Andrew J. Mullish, Benjamin H. Ghani, Rohma Szydlo, Richard M. Apperley, Jane F. Olavarria, Eduardo Palanicawandar, Renuka Kanfer, Edward J. Milojkovic, Dragana McDonald, Julie A. K. Brannigan, Eimear T. Thursz, Mark R. Williams, Horace R. T. Davies, Frances J. Marchesi, Julian R. Pavlů, Jiří Front Cell Infect Microbiol Cellular and Infection Microbiology The gut microbiome can be adversely affected by chemotherapy and antibiotics prior to hematopoietic cell transplantation (HCT). This affects graft success and increases susceptibility to multidrug-resistant organism (MDRO) colonization and infection. We performed an initial retrospective analysis of our use of fecal microbiota transplantation (FMT) from healthy donors as therapy for MDRO-colonized patients with hematological malignancy. FMT was performed on eight MDRO-colonized patients pre-HCT (FMT-MDRO group), and outcomes compared with 11 MDRO colonized HCT patients from the same period. At 12 months, survival was significantly higher in the FMT-MDRO group (70% versus 36% p = 0.044). Post-HCT, fewer FMT-MDRO patients required intensive care (0% versus 46%, P = 0.045) or experienced fever (0.29 versus 0.11 days, P = 0.027). Intestinal MDRO decolonization occurred in 25% of FMT-MDRO patients versus 11% non-FMT MDRO patients. Despite the significant differences and statistically comparable patient/transplant characteristics, as the sample size was small, a matched-pair analysis between both groups to non-MDRO colonized control cohorts (2:1 matching) was performed. At 12 months, the MDRO group who did not have an FMT had significantly lower survival (36.4% versus 61.9% respectively, p=0.012), and higher non relapse mortality (NRM; 60.2% versus 16.7% respectively, p=0.009) than their paired non-MDRO-colonized cohort. Conversely, there was no difference in survival (70% versus 43.4%, p=0.14) or NRM (12.5% versus 31.2% respectively, p=0.24) between the FMT-MDRO group and their paired non-MDRO cohort. Collectively, these data suggest that negative clinical outcomes, including mortality associated with MDRO colonization, may be ameliorated by pre-HCT FMT, even in the absence of intestinal MDRO decolonization. Further work is needed to explore this observed benefit. Frontiers Media S.A. 2021-08-27 /pmc/articles/PMC8430254/ /pubmed/34513724 http://dx.doi.org/10.3389/fcimb.2021.684659 Text en Copyright © 2021 Innes, Mullish, Ghani, Szydlo, Apperley, Olavarria, Palanicawandar, Kanfer, Milojkovic, McDonald, Brannigan, Thursz, Williams, Davies, Marchesi and Pavlů https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Cellular and Infection Microbiology
Innes, Andrew J.
Mullish, Benjamin H.
Ghani, Rohma
Szydlo, Richard M.
Apperley, Jane F.
Olavarria, Eduardo
Palanicawandar, Renuka
Kanfer, Edward J.
Milojkovic, Dragana
McDonald, Julie A. K.
Brannigan, Eimear T.
Thursz, Mark R.
Williams, Horace R. T.
Davies, Frances J.
Marchesi, Julian R.
Pavlů, Jiří
Fecal Microbiota Transplant Mitigates Adverse Outcomes Seen in Patients Colonized With Multidrug-Resistant Organisms Undergoing Allogeneic Hematopoietic Cell Transplantation
title Fecal Microbiota Transplant Mitigates Adverse Outcomes Seen in Patients Colonized With Multidrug-Resistant Organisms Undergoing Allogeneic Hematopoietic Cell Transplantation
title_full Fecal Microbiota Transplant Mitigates Adverse Outcomes Seen in Patients Colonized With Multidrug-Resistant Organisms Undergoing Allogeneic Hematopoietic Cell Transplantation
title_fullStr Fecal Microbiota Transplant Mitigates Adverse Outcomes Seen in Patients Colonized With Multidrug-Resistant Organisms Undergoing Allogeneic Hematopoietic Cell Transplantation
title_full_unstemmed Fecal Microbiota Transplant Mitigates Adverse Outcomes Seen in Patients Colonized With Multidrug-Resistant Organisms Undergoing Allogeneic Hematopoietic Cell Transplantation
title_short Fecal Microbiota Transplant Mitigates Adverse Outcomes Seen in Patients Colonized With Multidrug-Resistant Organisms Undergoing Allogeneic Hematopoietic Cell Transplantation
title_sort fecal microbiota transplant mitigates adverse outcomes seen in patients colonized with multidrug-resistant organisms undergoing allogeneic hematopoietic cell transplantation
topic Cellular and Infection Microbiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8430254/
https://www.ncbi.nlm.nih.gov/pubmed/34513724
http://dx.doi.org/10.3389/fcimb.2021.684659
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