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Review
. 2019 Jul 25:10:1704.
doi: 10.3389/fmicb.2019.01704. eCollection 2019.

Gut Microbiota Modulation for Multidrug-Resistant Organism Decolonization: Present and Future Perspectives

Livia Gargiullo  1 , Federica Del Chierico  2 , Patrizia D'Argenio  1 , Lorenza Putignani  3
Affiliations
Review

Gut Microbiota Modulation for Multidrug-Resistant Organism Decolonization: Present and Future Perspectives

Livia Gargiullo et al. Front Microbiol. .

Abstract

The emergence of antimicrobial resistance (AMR) is of great concern to global public health. Treatment of multi-drug resistant (MDR) infections is a major clinical challenge: the increase in antibiotic resistance leads to a greater risk of therapeutic failure, relapses, longer hospitalizations, and worse clinical outcomes. Currently, there are no validated treatments for many MDR or pandrug-resistant (PDR) infections, and preventing the spread of these pathogens through hospital infection control procedures and antimicrobial stewardship programs is often the only tool available to healthcare providers. Therefore, new solutions to control the colonization of MDR pathogens are urgently needed. In this narrative review, we discuss current knowledge of microbiota-mediated mechanisms of AMR and strategies for MDR colonization control. We focus particularly on fecal microbiota transplantation for MDR intestinal decolonization and report updated literature on its current clinical use.

Keywords: antimicrobial resistance; antimicrobial stewardship (AMS); antimicrobial stewardship program (ASP); clinical and laboratory advanced stewardship; fecal microbiota transplantation (FMT); microbiota modulation strategies; microbiota profiling; multidrug resistance (MDR) bacteria.

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Figures

FIGURE 1
FIGURE 1
Current strategies for MDR antimicrobial clinical and laboratory stewardship in hospital settings. AMS, antimicrobial stewardship; FMT, fecal microbiota transplantation; HSCT, hematopoietic stem cell transplantation; ICU, intensive care unit; MDR, multi-drug resistant; pts, patients; SOT, solid organ transplant.
FIGURE 2
FIGURE 2
Proposed model of advanced clinical and laboratory stewardship for MDR pathogen screening in hospital settings. AMS, antimicrobial stewardship; FMT, fecal microbiota transplantation; HSCT, hematopoietic stem cell transplantation; ICU, intensive care unit; MDR, multi-drug resistant; pts, patients; SOT, solid organ transplant; WGS, whole genome sequencing.
FIGURE 3
FIGURE 3
Combating antimicrobial resistance (AMR) through microbiota modulation.
See this image and copyright information in PMC

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