Fecal microbiota transplantation and successful resolution of multidrug-resistant-organism colonization

Abstract

We report a case in which fecal microbiota transplantation (FMT) utilized for relapsing Clostridium difficile colitis successfully eradicated colonization with several multidrug-resistant organisms (MDROs). FMT may have an additive benefit of reducing MDRO carriage and should be further investigated as a potential measure to eradicate additional potentially virulent organisms beyond C. difficile.

Copyright © 2015, American Society for Microbiology. All Rights Reserved.

Figures

FIG 1

(A) MDR pathogens isolated during 15 weeks pre-FMT and post-FMT. (B) MDR pathogens isolated subsequently during the remainder of the hospitalization period. CR, carbapenem resistant; CRE, carbapenem-resistant Enterobacteriaceae; MDR, multidrug resistant; MRSA, methicillin-resistant Staphylococcus aureus; VRE, vancomycin-resistant Enterococcus faecalis. 1, Pseudomonas aeruginosa (respiratory tract). Resistant to gentamicin, imipenem, levofloxacin, meropenem, and tobramycin; intermediate to piperacillin-tazobactam; susceptible to amikacin, cefepime, ceftazidime, and ciprofloxacin. 2, Acinetobacter baumannii (Jackson-Pratt [JP] drain in wound). Resistant to amikacin, cefepime, ciprofloxacin, gentamicin, levofloxacin, tobramycin, and trimethoprim-sulfamethoxazole; susceptible to ceftazidime, imipenem, and meropenem. 3, Klebsiella pneumoniae (ulcer). Resistant to amikacin, ampicillin-sulbactam, cefepime, ceftazidime, ciprofloxacin, gentamicin, imipenem, levofloxacin, meropenem, and piperacillin-tazobactam; susceptible to trimethoprim-sulfamethoxazole. 4, Acinetobacter baumannii (respiratory tract). Resistant to amikacin, cefepime, ceftazidime, ciprofloxacin, gentamicin, imipenem, levofloxacin, meropenem, and tobramycin. 5, methicillin-resistant Staphylococcus aureus (respiratory tract/urethral meatus/urine/abdominal fluid). Resistant to clindamycin and oxacillin; susceptible to doxycycline, linezolid, rifampin, and vancomycin (MIC = 1 per Phoenix method). 6, vancomycin-resistant Enterococcus faecalis (neck wound). Resistant to vancomycin; susceptible to ampicillin, daptomycin, and linezolid. 7, Providencia stuartii (respiratory tract). Resistant to ampicillin-sulbactam, cefazolin, ceftazidime, ceftriaxone, ciprofloxacin, gentamicin, tobramycin, and trimethoprim-sulfamethoxazole; intermediate to imipenem and piperacillin-tazobactam; susceptible to amikacin, cefepime, and meropenem. 8, Providencia rettgeri (urine). Resistant to ampicillin-sulbactam, cefazolin, ceftazidime, ceftriaxone, imipenem, and trimethoprim-sulfamethoxazole; intermediate to gentamicin; susceptible to amikacin, ciprofloxacin, levofloxacin, meropenem, piperacillin-tazobactam, and tobramycin. 9, Klebsiella pneumoniae (respiratory tract). Resistant to ampicillin-sulbactam, cefazolin, cefepime, ceftazidime, ceftriaxone, ciprofloxacin, imipenem, levofloxacin, meropenem, piperacillin-tazobactam, and tobramycin; intermediate to amikacin; susceptible to gentamicin and trimethoprim-sulfamethoxazole.