Clinical Infectious Diseases CORRESPONDENCE
Fecal Microbiota Transplantation and Urinary Tract Infection: An Interesting Approach
To the Editor—We have read with great interest the brief report published by Tariq et al. Authors should be congratulated for their attempt to evaluate the impact of fecal microbiota transplantation (FMT) in patients previously suffering from Clostridium difficile infections (CDIs) and having a medical past history of recurrent urinary tract infections (UTI) [1]. Indeed, in an era of multidrug-resistant organisms (MDRO) with increasingly limited therapies, a new solution is greatly appreciated [2]. Nevertheless, we should be extra careful about data presented regarding FMT, especially when patients are already having a dysbiotic microbiome as FMT previously showed discrepancies in the eradication of MDRO, especially when used for the decolonization of carbapenem-producing Enterobacteriaceae (CPE) and vancomyin-resistant Enterococcus (VRE) [3, 4]. Moreover, as Enterobacteriaceae are the most frequently encountered microorganisms in UTI, data cited by the authors regarding VRE and FMT should be balanced. Therefore, we believe some points should be discussed regarding their findings, although they are very interesting and original. First, we had no data concerning the reason why patients were considered to have recurrent UTI (neurological bladder? urinary incontinence?) and thus if patients were homogenous enough to be compared to each other. Some may have been suffering from asymptomatic bacteriuria with abdominal discomfort due to their recent CDIs. Further studies in healthy patients are warranted to support their findings.
Second, authors concluded that FMT might be interesting in recurrent UTI due to MDRO, but none of the tested strains prior the FMT have been classified as ampC or ESBL producers (Table 1) [1]. In addition, not all the strains are reported in Table 1 (n = 24); in other words, there should have been 35 positive urine samples cultured in the year before FMT, as stated in the supplementary data. Also there is no information concerning the antimicrobial resistance patterns in the control group, which would have permitted to conclude of a negative impact of FMT on MDRO development. Third, it should be noted that 25% of cases (n = 2) in the control group relapsed, whereas there was no relapse of CDI in the FMT group as expected [5]. Being free from abdominal discomfort and particularly diarrhea in the year they were monitored for UTI could explain why patients had significantly less UTI. Indeed, FMT may have technically resolved patient’s dysbiosis and therefore cured from bacteriuria including asymptomatic UTI. This idea is supported by a recent publication promoting a possible role of FMT in irritable bowel syndrome [6]. Despite the fact FMT is trendy and being recognized as a new effective weapon to fight MDRO colonization, harmonization and more data are needed in order to broader its use to UTI [7]. Yet, authors did not clarify the route of administration and doses of feces used for FMT. Overall, we would like to congratulate the authors for their effort to bring new therapeutics for recurrent UTI, especially in patients suffering from MDRO UTI, but we doubt that the methods employed and the sample size can authorize to conclude that FMT may be a valid approach.
Note Potential conflicts of interest. All authors: No reported conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed. Benjamin Davido, Aurélien Dinh, Laurene Deconinck, and Pierre de Truchis Maladies Infectieuses, Hôpital Raymond-Poincaré, AP-HP, Garches, France
References 1. Tariq R, Pardi DS, Tosh PK, Walker RC, Razonable RR, Khanna S. Fecal Microbiota transplantation for recurrent Clostridium difficile infection reduces recurrent urinary tract infection frequency. Clin. Infect. Dis. 2017; 45(Suppl):S159–67. Available at: https://academic.oup.com/cid/article-lookup/ doi/10.1093/cid/cix618. Accessed 21 July 2017. 2. Brandenburg K, Schürholz T. Lack of new antiinfective agents: passing into the pre-antibiotic age? World J Biol Chem 2015; 6:71–7. 3. Davido B, Batista R, Michelon H, et al. Is faecal microbiota transplantation an option to eradicate highly drug-resistant enteric bacteria carriage? J Hosp Infect 2017; 95:433–7. Available at: http://www.ncbi.nlm.nih.gov/pubmed/28237504. Accessed 6 May 2017. 4. Davido B, Batista R, Fessi H, Salomon J, Dinh A. Impact of faecal microbiota transplantation to eradicate vancomycin-resistant enterococci (VRE) colonization in humans. J Infect 2017. doi: 10.1016/j.jinf.2017.06.001. 5. van Nood E, Vrieze A, Nieuwdorp M, et al. Duodenal infusion of donor feces for recurrent Clostridium difficile. N Engl J Med 2013 Jan 31; 368(5):407–15. 6. Distrutti E, Monaldi L, Ricci P, Fiorucci S. Gut microbiota role in irritable bowel syndrome: new therapeutic strategies. World J Gastroenterol 2016; 22:2219–41. 7. Dinh A, Duran C, Bouchand F, Salomon J, Davido B. Fecal microbiota transplantation, a new effective weapon to fight multidrug resistant bacteria, but harmonization and more data are needed. Clin Infect Dis 2017. doi: 10.1093/cid/cix538.
Correspondence: B. Davido, Raymond Poincaré Teaching Hospital, Infectious Diseases, 104 Bd Raymond Poincaré, Garches, 92380 France (
[email protected]). Clinical Infectious Diseases® 2017;XX(00):1–1 © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail:
[email protected]. DOI: 10.1093/cid/cix788
CORRESPONDENCE • CID 2017:XX (XX XXXX) • 1
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