title: Fecal Microbial Transplants Reduce Antibiotic-resistant Genes in Patients With Recurrent Clostridium difficile Infection.
abstract: Recurrent Clostridium difficile infection (RCDI) is associated with repeated antibiotic treatment and the enhanced growth of antibiotic-resistant microbes. This study tested the hypothesis that patients with RCDI would harbor large numbers of antibiotic-resistant microbes and that fecal microbiota transplantation (FMT) would reduce the number of antibiotic-resistant genes.
  
  
  
  In a single center study, patients with RCDI (n = 20) received FMT from universal donors via colonoscopy. Stool samples were collected from donors (n = 3) and patients prior to and following FMT. DNA was extracted and shotgun metagenomics performed. Results as well as assembled libraries from a healthy cohort (n = 87) obtained from the Human Microbiome Project were aligned against the NCBI bacterial taxonomy database and the Comprehensive Antibiotic Resistance Database. Results were corroborated through a DNA microarray containing 354 antibiotic resistance (ABR) genes.
  
  
  
  RCDI patients had a greater number and diversity of ABR genes compared with donors and healthy controls. Beta-lactam, multidrug efflux pumps, fluoroquinolone, and antibiotic inactivation ABR genes were increased in RCDI patients, although donors primarily had tetracycline resistance. RCDI patients were dominated by Proteobacteria with Escherichia coli and Klebsiella most prevalent. FMT resulted in a resolution of symptoms that correlated directly with a decreased number and diversity of ABR genes and increased Bacteroidetes and Firmicutes with reduced Proteobacteria. ABR gene profiles were maintained in recipients for up to a year following FMT.
  
  
  
  RCDI patients have increased numbers of antibiotic-resistant organisms. FMT is effective in the eradication of pathogenic antibiotic-resistant organisms and elimination of ABR genes.
authors.affiliation: Department of Medicine, University of Alberta, Edmonton.
authors.forename: Braden
authors.initials: B
authors.lastname: Millan
authors.affiliation: Department of Medicine, University of Alberta, Edmonton.
authors.forename: Heekuk
authors.initials: H
authors.lastname: Park
authors.affiliation: Department of Medicine, University of Alberta, Edmonton.
authors.forename: Naomi
authors.initials: N
authors.lastname: Hotte
authors.affiliation: Lallemand Health Solutions, Montreal, Quebec, Canada.
authors.forename: Olivier
authors.initials: O
authors.lastname: Mathieu
authors.affiliation: Lallemand Health Solutions, Montreal, Quebec, Canada.
authors.forename: Pierre
authors.initials: P
authors.lastname: Burguiere
authors.affiliation: Lallemand Health Solutions, Montreal, Quebec, Canada.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Tompkins
authors.affiliation: Department of Medicine, University of Alberta, Edmonton.
authors.forename: Dina
authors.initials: D
authors.lastname: Kao
authors.affiliation: Department of Medicine, University of Alberta, Edmonton.
authors.forename: Karen L
authors.initials: KL
authors.lastname: Madsen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D016360:Clostridioides difficile / Q000187:drug effects* / Q000235:genetics; D024881:Drug Resistance, Bacterial / Q000235:genetics*; D004761:Enterocolitis, Pseudomembranous / Q000382:microbiology / Q000628:therapy*; D000069467:Fecal Microbiota Transplantation; D005243:Feces / Q000382:microbiology; D005260:Female; D000069196:Gastrointestinal Microbiome / Q000235:genetics*; D006801:Humans; D008297:Male; D008875:Middle Aged
chemical_list: D000900:Anti-Bacterial Agents
keywords: C. difficile; antibiotic resistance; antibiotics; colitis; intestinal microbiome