Page 193 - 2019_08-Haematologica-web

FMT in carriers of MDRB undergoing allo-HSCT
aeruginosa at day +80 after allo-HSCT while the other patient experienced a documented bacteriemia from an ESBL-producing Escherichia Coli at day 60 after allo-HSCT. The additional two patients undergoing FMT before allo- HSCT also received a large spectrum antibiotic such as piperacillin-tazobactam or cephalosporins for febrile neu- tropenia without documentation. Interestingly, despite
the use of large spectrum antibiotics, no cases of MDRB recurrence were observed in these four patients.
Fungal and viral infections were observed in only one patient more than six months after FMT, but these were not considered to be related to FMT because this patient was under systemic immunosuppressive treatments for a cortico-resistant extensive GvHD (lung, skin, mucosal)
Table 1. Characteristics of patients undergoing fecal microbiota transplantation before (A) or after (B) hematopoietic stem cell transplantation. A1234
Patientsex
Age at time of FMT, years
B
Hematologic malignancy
Identified MDRB
Antimicrobial resistance category
Concomitant MDR-ESBL-producing bacteria colonization, bacteria
Systemic infections due to MDRB before FMT
Time from FMT to allo-HSCT (days)
FMT donor
Way of administration
Major decolonization
Persistent decolonization
Concomitant ESBL-producing bacteria decolonization
Follow up after FMT, days
Follow up after allo-HSCT, days
Status
Cause of death
Patientsex F M FFFF
MMFM
64
AML
42 45 47
CP- Pseudomonas aeruginosa
CP-Pseudomonas aeruginosa CPE CPE° MDR MDR MDR
AML AML
BPDCN
XDR
Y
Y
41 Daughter Enema Y
Y
Y 820 779 Alive N/A
N Y N N N N 46 16 9 Sister Husband Sister
Enema Enema
Y Y Y Y Y Y
Enema
N/A N N/A 368 148 399 322 132 390 Dead Alive Alive
AgeattimeofFMT,years Hematologic malignancy Identified MDRB
Disease progression N/A N/A 50 54 16 19 62 54
MPN
CP- Pseudomonas
aeruginosa
MPN
CP- Pseudomonas
AML ALL MPN ALL
VRE VRE CPE
aeruginosa CPE
Antimicrobial resistance category
Concomitant MDR-ESBL-producing bacteria colonization N
Systemic infections due to MDRB before FMT Y
Time from allo-HSCT to FMT 324
FMT donor Husband
Way of administration Nasogastric tube
SecondFMT NYYYNN
PDR
N/A 27 118 84 N/A N/A
XDR
Y
Y
344 Unrelated Nasogastric tube
XDR XDR MDR XDR Y Y N Y N N N N 98 160 123 167
Mother Mother Brother Enema Enema Enema
Unrelated Enema
Time from first to second FMT, days Majordecolonization
Persistent decolonization
Concomitant ESBL-producing bacteria decolonization Colonization relapse
Follow-up after FMT, days Follow-up after allo-HSCT, days Status
Cause of death
Y N Y Y
N N N/A N/A N/A Y N/A N/A 184 307 307 474
Y N/A N 678 1002 Alive N/A
N/A
N
N/A
33
404
Dead Uncontrolled GvHD and infection
Y N N Y N Y 1220 595 1436 839 Alive Dead
N/A Disease
progression
Alive
N/A N/A
Alive
°Three different types: Citrobacter freundii, Klebsiella Pneumoniae, Enterobacter Cloacae. F: female; M: male; FMT: fecal microbiota transplantation; AML: acute myeloid leukemia; BPDCN: blastic plasmacytoid dendritic cell neoplasm; MDRB: multidrug-resistant bacteria; CP: carbapenemase-producing; CPE: carbapenemase-producing Enterobacteriaceae; XDR: extensively-drug resistant; MDR: multi-drug resistant; ESBL: extended-spectrum β-lactamase; Y: yes, N: no; allo-HSCT: allogeneic hematopoietic stem cell transplantation; GvHD: graft-versus-host disease; N/A: not applicable; MPN: myeloproliferative neoplasm; ALL: acute lymphoblastic leukemia; VRE: vancomycin-resistant enterococci; PDR: pan- drug resistant.
haematologica | 2019; 104(8)
1685