Fecal Microbiota Transplant in Cirrhosis Reduces Gut Microbial Antibiotic Resistance Genes: Analysis of Two Trials.
Adult
Aged
Anti-Bacterial Agents
/ administration & dosage
Drug Resistance, Microbial
Fecal Microbiota Transplantation
/ methods
Female
Gastrointestinal Microbiome
/ drug effects
Humans
Lactulose
/ therapeutic use
Liver Cirrhosis
/ pathology
Male
Middle Aged
Proton Pump Inhibitors
/ therapeutic use
Rifaximin
/ therapeutic use
Treatment Outcome
Young Adult
Journal
Hepatology communications
ISSN: 2471-254X
Titre abrégé: Hepatol Commun
Pays: United States
ID NLM: 101695860
Informations de publication
Date de publication:
02 2021
02 2021
Historique:
received:
16
09
2020
revised:
21
10
2020
accepted:
22
10
2020
entrez:
8
2
2021
pubmed:
9
2
2021
medline:
9
2
2021
Statut:
epublish
Résumé
Antibiotic resistance leads to poor outcomes in cirrhosis. Fecal microbiota transplant (FMT) is associated with reduction in antibiotic resistance gene (ARG) burden in patients without cirrhosis; however, the impact in cirrhosis is unclear. We aimed to study the effect of capsule and enema FMT on ARG abundance in fecal samples, which were collected during two published FMT trials in patients with cirrhosis on rifaximin, lactulose, and proton pump inhibitors. ARGs were identified using metagenomics and mapped against the Comprehensive Antibiotic Resistance Database. Changes in ARG abundance were studied within/between groups. The capsule FMT trial involved a one-time FMT or placebo capsule administration with stool collection at baseline and week 4 postintervention. Antibiotics+enema FMT included preprocedure antibiotics followed by FMT enema versus standard-of-care (SOC). Stool was collected at baseline, postantibiotics, and day 7/15 postintervention. Both trials included 20 patients each. There was no safety/infection signal linked to FMT. In the capsule trial, beta-lactamase (OXY/LEN) expression decreased post-FMT versus baseline. Compared to placebo, patients who were post-FMT had lower abundance of vancomycin (VanH), beta-lactamase (ACT), and rifamycin ARGs; the latter was associated with cognitive improvement. No changes were seen within patients treated with placebo. In the antibiotics+enema trial for postantibiotics at day 7 versus baseline, there was an increase in vancomycin and beta-lactamase ARGs, which decreased at day 15. However, quinolone resistance increased at day 15 versus baseline. Between SOC and FMT, day 7 had largely lower ARG (CfxA beta-lactamase, VanW, and VanX) that continued at day 15 (cepA beta-lactamase, VanW). No changes were seen within the SOC group.
Identifiants
pubmed: 33553973
doi: 10.1002/hep4.1639
pii: 02009842-202102000-00011
pmc: PMC7850310
doi:
Substances chimiques
Anti-Bacterial Agents
0
Proton Pump Inhibitors
0
Lactulose
4618-18-2
Rifaximin
L36O5T016N
Types de publication
Clinical Trial, Phase I
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, Non-P.H.S.
Langues
eng
Pagination
258-271Subventions
Organisme : NCATS NIH HHS
ID : R21 TR002024
Pays : United States
Organisme : NCATS NIH HHS
ID : R21 TR003095
Pays : United States
Informations de copyright
© 2020 The Authors. Hepatology Communications published by Wiley Periodicals LLC on behalf of the American Association for the Study of Liver Diseases.
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