{"doi":"10.1126/scitranslmed.abo2750","title":"Fecal microbiota transplantation promotes reduction of antimicrobial resistance by strain replacement","abstract":"Multidrug-resistant organism (MDRO) colonization is a fundamental challenge in antimicrobial resistance. Limited studies have shown that fecal microbiota transplantation (FMT) can reduce MDRO colonization, but its mechanisms are poorly understood. We conducted a randomized, controlled trial of FMT for MDRO decolonization in renal transplant recipients called PREMIX (NCT02922816). Eleven participants were enrolled and randomized 1:1 to FMT or an observation period followed by delayed FMT if stool cultures were MDRO positive at day 36. Participants who were MDRO positive after one FMT were treated with a second FMT. At last visit, eight of nine patients who completed all treatments were MDRO culture negative. FMT-treated participants had longer time to recurrent MDRO infection versus PREMIX-eligible controls who were not treated with FMT. Key taxa ( Akkermansia muciniphila , Alistipes putredinis , Phocaeicola dorei , Phascolarctobacterium faecium , Alistipes species, Mesosutterella massiliensis , Barnesiella intestinihominis , and Faecalibacterium prausnitzii ) from the single feces donor used in the study that engrafted in recipients and metabolites such as short-chain fatty acids and bile acids in FMT-responding participants uncovered leads for rational microbiome therapeutic and diagnostic development. Metagenomic analyses revealed a previously unobserved mechanism of MDRO eradication by conspecific strain competition in an FMT-treated subset. Susceptible Enterobacterales strains that replaced baseline extended-spectrum β-lactamase–producing strains were not detectable in donor microbiota manufactured as FMT doses but in one case were detectable in the recipient before FMT. These data suggest that FMT may provide a path to exploit strain competition to reduce MDRO colonization.","journal":"Science Translational Medicine","year":2023,"id":316230,"datarank":2.3006203642386,"base_score":4.7535901911063645,"endowment":4.7535901911063645,"self_citation_contribution":0.7130385286659547,"citation_network_contribution":1.5875818355726452,"self_endowment_contribution":0.7130385286659547,"citer_contribution":1.5875818355726452,"corpus_percentile":null,"corpus_rank":null,"citation_count":115,"citer_count":99,"citers_with_citation_signal":71,"citers_with_endowment":71,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9579,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1019633,"name":"Roth E. 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