Faecal microbiota transplantation for the decolonisation of antibiotic-resistant bacteria in the gut: a systematic review and meta-analysis

Summary Background Antibiotic resistance is a growing global problem associated with increased morbidity and mortality, and presents a significant financial and economic burden on healthcare. FMT has been proven effective for curing recurrent Clostridium difficile infections, however no systematic review to date has addressed its effectiveness for decolonisation of antibiotic-resistant bacteria from the gut. Aim To answer the following research question: Does faecal microbiota transplantation decolonise antibiotic-resistant bacteria from the gut of colonised adults? Methods A systematic review was performed by undertaking a comprehensive search on MEDLINE, Embase, CENTRAL, PubMed and CINAHL databases for evidence up till May 2018. Randomised and non-randomised studies evaluating the effects of FMT on gut colonisation of antibiotic-resistant bacteria in adults were eligible. Studies were assessed using JBI critical appraisal checklists. Quality of reporting was assessed using PROCESS and CARE checklists. Data was synthesized narratively, along with a meta-analysis of proportions for the primary outcome. Findings Five studies with a total number of 52 participants were included. Evidence of low quality showed that decolonisation was achieved in half of the cases one month after FMT with higher response noted in Pseudomonas aeruginosa , and lower response in Klebsiella pneumoniae with NDM-1 and ESBL mechanisms of resistance. In successful cases, 70% of decolonisation cases occurred within the first week after FMT. Few temporary adverse events were identified. Conclusion Despite the limitations of the included studies, evidence from this review indicates a potential benefit of FMT as a decolonisation intervention, which can only be confirmed by future well-designed RCTs.