, Lee, , Choi, , Shin, , and Kim: Fecal Microbiota Transplantation against Gut Colonization Using a Multidrug-Resistant Organism

Seul Ki Lee1Ji Eun Choi1Chae Min Shin2*Mi-Na Kim3

1Division of Healthcare Technology Assessment Research, Korea
2Division for New Health Technology Assessment, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
3Department of Laboratory Medicine Asan Medical Center University of Ulsan College of Medicine, Seoul, Korea


*Corresponding author: E-mail: blu0924@neca.re.kr


ABSTRACT

Background: Fecal microbiota transplantation against gut colonization using a multidrug-resistant organism is a technique used to treat infections through normalizing the gut microbiota via fecal microbiota transplantation in patients with confirmed colonization by carbapenem-resistant Enterobacteriaceae (CRE) or vancomycin-resistant enterococci (VRE) based on a fecal culture test within the past one week. In this study, we aimed to determine the safety and effectiveness of this technique.

Methods: The safety and effectiveness were assessed via a systematic review. A literature search was conducted using five Korean databases, such as KoreaMed, and international databases, including Ovid-MEDLINE, Ovid-EMBASE, and Cochrane Library.

Results: Main results are described here. From the studies retrieved using the aforementioned search strategy, the remaining 581 studies were screened using the inclusion and exclusion criteria, resulting in the selection of nine studies for further consideration. In terms of safety, many studies reported deaths and adverse reactions associated with different causes. Fewer studies reported the rate of colonization; however, the effect of colony rate was inconsistent when compared to no treatment group. Additionally, none of the studies assessed the recurrence rate, a decrease in the prevalence of diseases related to infection by multidrug-resistant bacteria, and the quality of life.

Conclusion: Fecal bacterial colonization for the decolonization of intestinal multidrug-resistant bacteria was evaluated using a technique that requires further research as there is insufficient literature evidence to validate its safety and efficacy in treating infections through normalizing the intestinal flora of patients with confirmed colonization by CRE or VRE.

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Table 1

SIGN criteria for assignment of levels of evidence

Level

Description

1++

High quality meta-analyses, systematic reviews of RCTs, or RCT with a very low risk of bias

1+

Well-conducted meta-analyses, systematic reviews, or RCTs with a low risk of bias

1-

Meta-analyses, systematic reviews, or RCTs with a high risk of bias

2++

High quality systematic reviews of case control or cohort or studies

2+

High-quality case-control or cohort studies with a very low risk of confounding or bias and a high probability that the relationship is causal

2-

Well-conducted case-control or cohort studies with a low risk of confounding or bias and a moderate probability that the relationship is causal

3

Case-control or cohort studies with a high risk of confoundingo r bias and a significant risk that the relationship is not causal

4

Expert opinion

Abbreviatons: SIGN, Scottish intercollegiate guideline network; RCT, randomized controlled trial.

Table 2. SIGN criteria for assignment of levels of grades of recommendation

Level

Description

A

At least one meta-analysis, systematic review, or RCT rated as 1++, and directly applicable to the target population; or a body of evidence consisting principally of studies rated as 1+, directly applicable to the target population, and demonstrating overall consistency of results

B

A body of evidence including studies rated as 2++, directly applicable to the target population, and demonstrating overall consistency of results; or extrapolated evidence from studies rated as 1++ or 1+

C

A body of evidence including studies rated as 2+, directly applicable to the target population and demonstrating overall consistency of results; or extrapolated evidence from studies rated as 2++

D

Evidence level 3 or 4; or extrapolated evidence from studies rated as 2+

Abbreviatons: SIGN, Scottish intercollegiate guideline network; RCT, randomized controlled trial.