Fecal transplant to treat recurrent urinary tract infection
Leveraging a microbiome approach.
A potential treatment option for recurrent multidrug-resistant infections
The gut holds 100 trillion organisms, many of which positively and negatively impact the health of the brain and immune system.
Unhealthy microbes, called facultative anaerobes, live inside or outside the body and can cause infection. Healthy microbes, called strict anaerobes, thrive inside the gut so long as facultative anaerobes do not proliferate and take over.
Herbert DuPont, MD, Chief Scientific Officer of the Optum collaborative partner Kelsey Research Foundation and clinician at the Kelsey-Seybold Clinic, is an infectious disease physician with a long-standing interest in the microbiome. In 2022, he and a team of scientists submitted for publication a case study highlighting the successful treatment of a recurrent urinary tract infection (UTI) using fecal transplant.
Fecal transplant case study
Dr. DuPont and the team’s case study focused on a 50-year-old woman with von Willebrand disease and multiple antibiotic allergies. For 15 years, she had suffered from recurrent UTIs stemming from complications of a hysterectomy. Doctors had used every antibiotic possible to control her UTIs. However, these efforts only resulted in her developing a drug-resistant infection with extended-spectrum b-lactamase (ESBL)-producing Klebsiella pneumoniae.
The patient and her providers pursued fecal microbiota transplantation (FMT) to avoid daily courses of IV antibiotics. Fecal transplants have been around since the 1970s. They use an oral encapsulated lyophilized stool product already under investigation to treat Clostridioides difficile (C. diff) infections.
Dr. DuPont and the team followed the patient for 18 months after FMT, tracking any new UTIs and analyzing their associated microbes. During this time, no new infections with ESBL-producing organisms occurred.
Notable insights
Dr. DuPont says the success of this type of treatment highlights its potential for combating hospital-acquired infections.
“I think we need to take a microbiome approach to infection control, including appropriate use of narrow spectrum antibiotics coupled with encouraging patients to eat a microbiome-friendly diet,” Dr. DuPont says. “This could reduce many hospital-acquired infections, such as C. diff.
“Patients who develop C. diff have often received many courses of antibiotics. They harbor large quantities of antibiotic-resistant bacteria. We’ve shown those resistant forms disappear when we do a fecal transplant.”
Next steps
Dr. DuPont says the microbiome, including the use of fecal transplant, has implications beyond infection control. He’s published research highlighting the many ways this treatment has been used, including for symptom improvement in Parkinson’s disease.
He’s now studying how to develop disease-specific probiotics from isolated strains of good bacteria collected from patients who have responded well to FMT.
Fig. 1. Timeline of clinical course. Numbers indicate approximate timing of urine and stool collection. Axyl, Achromobacter xylosoxidans; CIP, ciprofloxacin; Efs, Enterococcus faecalis; ETP, ertapenem; FMT, fecal microbiota trans- plantation; LVX, levofloxacin; MEM, meropenem; Steno, Stenotrophomonas maltophilia; Ur. Cx, urine culture.
The need to do more
Dr. DuPont says taking a microbiome-based approach has the potential to revolutionize the way hospitals think about infection prevention and control. These go beyond current efforts aimed at improving the way appropriate antibiotics are prescribed and used.
“Right now, we use antibiotics to fight infection, but antibiotic resistance has led to increased infection rates. Antibiotic stewardship programs have helped, but we can continue to do more.”
A microbiome approach, he says, is just the start.
"Hospitals could routinely test patients’ microbiome to determine if they are harboring resistant organisms,” Dr. DuPont says. “They could then use that information to change diet and nutrition in the hospital to encourage positive microbiome changes.”
Achieving the Quadruple Aim
- Patient satisfaction: he delivery method (an enteric-coated pill) and the possible positive results of FMT are patient satisfiers. Especially considering the quality-of-life improvements possible with this treatment method
- Clinician well-being: N/A
- High-quality outcomes: N/A
- Affordable health care: N/A
Miller, William R., et al. “A case of successful treatment of recurrent urinary tract infection by extended-spectrum β-lactamase producing Klebsiella pneumoniae using oral lyophilized fecal microbiota transplant.” Microbial Drug Resistance, January 2023. liebertpub.com/doi/10.1089/mdr.2022.0031