We know everyones into the play off game right now, but its always exciting to see whats up in the world of fecal transplants! Fecal Transplant Eliminates Persistent MDR Infection Daniel M. Keller, PhD PHILADELPHIA — Fecal microbiota transplantation successfully decolonized the gut of a young girl who persistently harbored multidrug-resistant Klebsiella pneumoniae bacteria, according to a case report. The treatment is increasingly being used to manage recurrent or refractory Clostridium difficile infections, but this is the first instance of its use to decolonize carbapenem-resistant enterobacteriaceae and return normal flora to the gut, the researchers report. The case of a 13-year-old girl with a history of recurrent otitis media and otomastoiditis whose operative cultures grew Pseudomonas aeruginosa was described here at IDWeek 2014 by Abigail Freedman, MD, attending physician at Alfred I. duPont Hospital for Children in Wilmington, Delaware. The patient was treated with broad-spectrum antibiotics, but continued to have pain and positive superficial cultures. She was readmitted to the hospital a month later with a persistent fever and was diagnosed with hemophagocytic lymphohistiocytosis. She improved after treatment with high-dose corticosteroids and etoposide, and was discharged. Two months later, after the onset of a new fever, her blood cultures revealed highly multidrug-resistant carbapenemase-producing Klebsiella pneumoniae. Antibiotics failed to clear the organism from her blood, and she developed septic arthritis in one shoulder and both hips. With just about no antibiotic choices left, Dr Freedman turned in desperation to the Internet for help and, she said, a wondrous group of consultants came forth to help. Suggestions of an extended infusion of doripenem, colistin, rifampin, and plazomicin (an aminoglycoside in phase 3 trials) controlled the bloodstream infection. The patients joints were washed out with polymyxin. We know it works, but we really dont understand how it works. But the possibility of persistent colonization with carbapenemase-producing Klebsiella pneumoniae and the re-emergence of active infection when antibiotics were stopped loomed because of the patients underlying hemophagocytic lymphohistiocytosis and immunosuppression from heavy steroid therapy. Although she remained asymptomatic for several months, carbapenemase-producing Klebsiella pneumoniae was found in her stool, and 7 months after stopping antibiotics, she developed severe osteomyelitis of the femur with the same organism. At that point, she underwent fecal transplantation. A younger, healthy, fully immunized, antibiotic-free half-brother became the donor after his stool tested negative for bacteria and viruses of concern and for ova and parasites. Donor stool (25 to 30 g) was homogenized in 60 mL normal saline in a Hamilton Beach Personal Blender. The homogenate was then filtered twice through commercially available unbleached coffee filters. The procedure itself took less than 10 minutes — after hours of preparation — and was very simple and benign, Dr Freedman reported. Using a nasoduodenal tube, 25 mL of filtrate was administered, and the patient remained in a semi-upright position for an hour after the procedure. She reported only mild transient nausea and experienced no complications.
Posted on: Sun, 18 Jan 2015 21:58:54 +0000
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