According to an April 30 press release from Digestive Disease Week, a new pilot study suggests that fecal microbial transplantation (FMT) may offer some benefit for people who suffer from antibiotic-resistant bacterial infections. FMT, a procedure that involves transferring a healthy person’s poop into the gut of a sick person, is thought to work by restoring the bacterial balance that has been thrown off by drug-resistant superbugs. For the study, researchers gave FMT to 20 patients with intestinal colonization of multidrug-resistant organisms, including carbapenemase-producing Enterobacteriaceae and vancomycin-resistant enterococci or extended-spectrum beta-lactamase Enterobacteriaceae. The sample included patients with blood cancer in need of stem-cell transplants, and kidney transplant patients with urinary and bloodstream infections. They compared the clinical course of treatment in patients before the FMT and six months after the procedure. While resistant bacteria were cleared in only 41 percent of the 17 patients who completed the study, “results show that patients who received FMT required less time in hospital, had fewer bloodstream infections, and required less of a very strong class of antibiotics than in the six months prior to FMT,” says Benjamin Mullish, MD, one of the study’s authors and a clinical lecturer in the division of digestive diseases at Imperial College London. RELATED: Siblings the Best Option for Fecal Transplant Success, Study Finds
How Does Our Gut Play a Role?
People whose guts are populated with antibiotic-resistant bacteria are susceptible to infections in other parts of the body, such as the bloodstream or urinary tract, explains Colleen Kelly, MD, a gastroenterologist and an associate professor of medicine at Brown University in Providence, Rhode Island, who was not involved with the study. “The bacteria can cross the wall of the intestine into the bloodstream in patients who are very sick. They may contaminate intravenous or urinary catheters, or they can be transmitted on the hands of healthcare workers to other patients.” While Dr. Kelly did find the study compelling, she cautions that without a control group it’s not clear that the FMT is what had an effect on the resistant bacteria, or if they simply resolved with time. FMT has already been shown to be effective in treating Clostridium difficile, also known as C. diff, a superbug that is resistant to many antibiotics. But, Kelly cautions, that doesn’t mean it will work for every medical condition or bacterial infection. “While the medical community is really excited about these emerging therapies in the gut microbiome, the research is still exploratory,” she says. “There’s still potential for infection or other long-term risks that we cannot predict, so we have to be mindful of that.”
What You Should Know About Fecal Transplants
While the idea of putting someone’s poop into another person may make you queasy, the procedure is more sanitary than you may think. The stool is highly refined, which means it’s been filtered and rinsed in saline, looks like a powder, and has no odor. The capsules contain pure bacteria, which is usually delivered by colonoscopy or with an enema. FMT isn’t available for everyone — the FDA allows the treatment only for people with recurring C. diff. This can be frustrating for those who struggle with conditions like inflammatory bowel diseases or autoimmune disorders and who think FMT may be a promising natural alternative. Indeed, in recent years, more people are performing do-it-yourself FMT at home. In a study published in April 2020 in the American Journal of Gastroenterology, of 84 people who completed a survey, most reported performing FMT on themselves, using information they found on the internet to guide them in the procedure. Inflammatory bowel diseases, including Crohn’s and ulcerative colitis, and irritable bowel syndrome were the most common conditions that survey participants attempted to treat. There’s no sound efficacy data on FMT, and it may even be dangerous, setting you up for an infection, Kelly says. “Stool may be natural, but not everything that is natural is safe.” For example, two patients involved in a clinical trial for FMT conducted in 2019 at Massachusetts General Hospital in Boston suffered an infection after receiving FMT from a donor who tested positive for extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (E. coli), a specific type of resistant bacteria. One of the patients died. “FMT is an interesting investigative tool, but there are some problems with its use,” says Dr. Mullish. “The ultimate aim of doctors and scientists who are interested in FMT is to understand the mechanisms by which it works, with the aim of moving FMT from its current crude state to new, more targeted treatments that avoid the drawbacks of FMT.” The pilot study results will be published in the May online supplements to the journals Gastroenterology and GIE: Gastrointestinal Endoscopy.
