iterative fecal microbiota transplantations 1265
Preliminary findings were presented at the local Coastline Chapter of the Association of Professionals in Infection Control and Epidemiology (APIC) March 10, 2016, in Torrance, California. Infect Control Hosp Epidemiol 2017;38:1263–1265 © 2017 by The Society for Healthcare Epidemiology of America. All rights reserved. 0899-823X/2017/3810-0023. DOI: 10.1017/ice.2017.166
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3. Edwards R, Drumright L, Kiernan M, Holmes A. Covering more territory to fight resistance: considering nurses’ role in anti- microbial stewardship. J Infect Prev 2011;12:6–10.
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recent review of the literature demonstrated that according to US-based studies, the percentage of CPE isolates that could be associated with the community ranged from 5.6% to 10.8%.3 We have recently demonstrated the less effective effect of fecal microbiota transplantation (FMT) on CPE compared to vancomycin-resistant Enterococci (VRE) fecal carriage.4 Those results are consistent with another recent study5 conducted in 6 patients colonized with CPE and showing an eradication of the colonization in only 2 of these 6 patients. In these studies, the decolonization procedure included only 1 FMT procedure. One hypothesis is that a protocol including iterative FMTseparated by a several-day latency could increase the effectiveness of the procedure. Our objective was to evaluate the impact of iterative FMT
for the clearance of CPE carriage in our mouse model of digestive colonization. Ethical approval was obtained from the Ethical Committee in Animal Experimentation of Pays-de- la-Loire, France (reference no. 2015041415088410/APAFIS 513) and was conducted according to European directives con- cerning the use of animals in research (86/609/EEC). In this model, 28 8-week-old mice (Swiss type) were used.
The normal digestive flora were disrupted with the daily oral administration of a combination of antimicrobial agents including vancomycin (50 mg/kg), metronidazole (25 mg/kg), and ceftriaxone (25 mg/kg) over 5 days (ie, day 1 to day 5). Mice were then randomized to receive a high inoculum (5×109 bacteria) of a strain of Escherichia coli producing a New Delhi metallo-β-lactamase-1 (NDM-1). Those bacteria were inoculated to the mice via oral gavage on day 4, day 5, and day 8. Mice were housed in individual cages. Fecalmicrobiota were collected daily from related (Swiss mice
Iterative Fecal Microbiota Transplantations for Eradicating Digestive Colonization With Carbapenemase-Producing Enterobacteriaceae: Is It Worth It?
To the Editor—Carbapenemase-producing Enterobacteriaceae (CPE) have emerged as a major source of bacterial resistance, and their dissemination is a serious public health threat.1 Furthermore, those bacteria can disseminate outside the hospital setting. A large study including 34 hospitals in Spain
demonstrated that a significant proportion of patients identi- fied as colonized or infected with CPE during hospitalization probably acquired this organism in a nursing home during the period preceding their hospital admission.2 In addition, a
of the same age) untreatedmice. Stool suspensions forFMTwere prepared and stored as previously described.4 On day 10, mice were randomized to receive FMT(14mice) or placebo (14 mice). During the experiment, 4 series of FMTor placebo administration were performed on all mice. In each series, the mice received FMT or placebo once daily for 3 successive days (from day 10 to day 12, from day 23 to day 25, from day 37 to day 39, and from day 49 to day 51) by oral gavage with 200 µL of the stool suspension or 200 µL of saline, respectively. Stools were collected 3 times per week until day 57 and
were weighed for quantitative cultures. Stool samples were seeded on agar media (ChromID CARBA, bioMérieux, France) after serial dilutions for CPE screening. Bacterial identification of CPE colonies was controlled using matrix- assisted laser desorption/ionization time-of-flight mass spectroscopy (MALDI-TOF MS, Vitek MS, bioMérieux). A mouse was considered decolonized when 3 successive stool samples (corresponding to 4 or 5 days of follow-up) were negative for CPE. The evolution of the percentage of colonized mice during
the follow-up period was studied using Kaplan-Meier analysis (SPSS version 15.0 software, IBM, Armonk, NY). The com- parison between the FMT group and the placebo group was performed using the log-rank test. The comparison of the
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