Fecal microbiota transplantation promotes reduction of antimicrobial resistance by strain replacement

Those who must use antibiotic prophylaxis to prevent opportunistic infections are at high risk for intestinal colonization and infection by multi-drug resistant organisms (MDROs). Here, Woodworth and colleagues conducted a randomized controlled trial to compare the safety, efficacy, and strain dynamics of MDRO eradication after bowel preparation plus fecal microbiota transfer (FMT) versus bowel preparation alone in 11 renal transplantation recipients. FMT resulted in faster MDRO decolonization and protected study participants from recurrent infection. In some participants, extended spectrum β-lactamase (ESBL)–producing strains were replaced by non-ESBL strains, suggesting that strain competition rather than eradication may occur after FMT. These findings support the efficacy of FMT and provide valuable insights into the mechanisms by which FMT may lead to MDRO decolonization.