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We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com. Back to Healio Key takeaways: A single session of FMT did not significantly decolonize multidrug-resistant organisms in the microbiome. Researchers still observed evidence of positive microbiome restructuring with FMT. While a single fecal microbiota transplantation session did not significantly improve multidrug-resistant organism decolonization among patients with gastrointestinal disease, it may prompt microbiome restructuring, study results showed. Researchers noted that the enrichment of certain bacteria among patients in the FMT cohort, which was not observed in a sham intervention cohort, warrants further research.
Data derived from\u00a0Narang H et al. JAMA Intern Med. 2026;doi:10.1001\/jamainternmed.2026.0655.
\u201cThese findings should be interpreted in the context of the specific patient population and the single session FMT protocol used, and should not be taken as refuting microbiota-based therapeutic approaches as potential strategies for [multidrug-resistant organisms] decolonization,\u201d Himanshu Narang, DM, assistant professor in the department of gastroenterology and human nutrition at All India Institute of Medical Sciences, and colleagues wrote. \u201cThis study also found that FMT induced shifts in the gut microbiome,\u201d they added. \u201cNotably, bacteria with capacity to produce short chain fatty acids, such as Dorea, Holdemanella, Lachnospira, Agathobacter and Eubacterium, were enriched following FMT, suggesting a shift toward gut microbial communities that support gut health and metabolic function.\u201d Because of a lack of FDA-approved therapies to prevent infection from multidrug-resistant organisms (MDRO), Narang and colleagues decided to conduct a randomized, sham-controlled study to assess efficacy of FMT in promoting MDRO decolonization and\/or decreasing antimicrobial resistance genes. The study included 114 patients aged 18 to 75 years (70.2% men; mean age, 40.6 years) with GI diseases and persistent MDRO colonization. They were studied in a gastroenterology ward and ICU at a tertiary care center in India. Of the trial population, 58 patients received FMT via colonoscopy and 56 patients received a sham intervention. Patients had previously been diagnosed with pancreatitis (45.6%), cirrhosis (37.7%) or other GI disorders (16.7%). At baseline, the majority of patients (FMT group, 94.8%; sham group, 100%) were colonized with carbapenem-resistant Enterobacteriaceae or extended spectrum beta-lactamase-producing Enterobacteriaceae. MDRO decolonization rate and decrease in antimicrobial resistance genes at 4 weeks served as coprimary endpoints. Secondary endpoints included changes in stool microbiome, among others. After the intervention, data showed no significant difference between FMT and sham groups in MDRO decolonization (31% vs. 30.4%; absolute difference, 0.6%; 95% CI, \u201316.2% to 17.6%) or antimicrobial resistance genes (median, 2.5 genes vs. 2 genes). However, gene-sequencing analysis conducted among 71 patients (FMT group, n = 38; sham group, n = 33) 4 to 6 weeks after the intervention showed microbial diversity increased, but did not reach donor levels. No significant differences were observed among patients from the sham group. Researchers acknowledged study limitations, including its heterogeneous study population, not assessing potential influence of diet to MDRO decolonization and performing MDRO decolonization assessments only 4 weeks after the intervention. They said that additional large, multicenter studies are needed to help determine FMT\u2019s place in gut MDRO decolonization. Perspective Back to Top This study addresses one of the more difficult problems we increasingly encounter in modern gastroenterology and hospital medicine: persistent colonization with multidrug-resistant organisms, or MDROs. Patients with cirrhosis, pancreatitis and other complex GI diseases are frequently exposed to antibiotics, recurrent hospitalizations and invasive procedures, all of which contribute to disruption of the gut microbiome and selection of resistant organisms. The idea of restoring colonization resistance through FMT is, therefore, highly appealing from a biologic standpoint. What I found most important about this trial is the quality of the study design. Much of the prior literature supporting FMT for MDRO decolonization has been limited by small observational cohorts and the lack of appropriate controls. Here, the investigators performed a randomized, sham-controlled trial and coupled the clinical outcomes with detailed microbiome analyses, which provides a much stronger level of evidence. Although the study did not demonstrate statistically significant improved MDRO decolonization or reduction in antimicrobial resistance genes after a single FMT session, I do not think the findings diminish the broader potential of microbiome-directed therapeutics. In fact, the observed enrichment of beneficial short-chain fatty acid-producing bacteria after FMT suggests that meaningful biologic modulation did occur, even if this did not immediately translate into eradication of resistant organisms. The negative primary outcome likely reflects the complexity of MDRO colonization itself. These patients often have ongoing health care exposures, repeated antibiotic use, altered immunity and profound microbiome disruption that may not be reversible with a single intervention. It is possible that future strategies involving repeated FMT administration, more targeted microbial consortia or precision microbiome therapeutics may ultimately prove more effective. Overall, I view this as an important and clinically meaningful study because it helps move the field beyond anecdotal enthusiasm and toward evidence-based understanding of where FMT may or may not have therapeutic benefit in MDRO management.
Disclosures: Alsakarneh reports no relevant financial disclosures.
Perspective Back to Top This report is a fascinating exploration of the use of microbiome restorative therapy to alter the course of MDRO colonization. Gut colonization with MDRO can act as a reservoir for invasive infection with these organisms. Hospitalized patients, chronic care facility patients and those with immune suppression are at particular risk. MDRO organisms include vancomycin-resistant Enterococcus, extended-spectrum beta-lactamase-producing Enterobacter, carbapenem-resistant Enterobacter and multidrug-resistant Gram-negative bacilli. The primary goal of this paper was to see if restoring the gut biome could lead to decolonization of the MDRO and decrease the presence of antimicrobial resistance genes. Although the paper did not demonstrate this, it achieved secondary goals of altering gut biome composition via 16s ribosomal RNA gene sequencing. Microbiome restorative therapy has been successful in breaking the cycle of recurrent C.<\/p>\n","protected":false},"author":1,"featured_media":3054,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-3053","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/posts\/3053","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=3053"}],"version-history":[{"count":0,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/posts\/3053\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/media\/3054"}],"wp:attachment":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=3053"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=3053"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=3053"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
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