2228. Impact of amoxicillin/clavulanate and autologous fecal microbiota transplantation on the fecal microbiome and resistome
Session: Poster Abstract Session: Microbiome: GI
Saturday, October 29, 2016
Room: Poster Hall

Background: Strategies to prevent infections due to multidrug-resistant organisms (MDRO) are scarce, but it may be possible to limit gastrointestinal MDRO colonization through fecal microbiota transplantation. Our objective was to determine the impact of autologous FMT (auto FMT) on the restoration of the gastrointestinal microbiome after antimicrobial exposure.

Methods: Ten healthy subjects received five days of amoxicillin/clavulanate (amox/clav) 875 mg BID. Half were randomized to auto FMT by enema and half to saline by enema. Stool was obtained before and after antibiotics, immediately following enema, and at days 7, 30, and 90 post-enema. Shotgun metagenomic sequencing facilitated species composition analysis and resistance gene annotation. Species were identified using MetaPhLan and Beta Lactam resistance genes were identified using ShortBRED and the Lahey database.

Results:

Community Diversity

Effects on the gut microbiota composition varied in response to antibiotics (Fig 1). Most notably, Subject 8 exhibited a bloom of Proteobacteria. Normal composition was restored after auto FMT. Additionally, amox/clav increased Bacteroidetes in some subjects (1-5) but not in subjects that began with high Bacteroidetes levels (6, 7, 10). Bacteroidetes returned to normal levels in both treatment and control groups.  

Description: Macintosh HD:Users:christopherbulow:Desktop:All_FMT_Spec_unBlind_v2.png

Abundance of Beta Lactam Resistance Genes

Subjects 7 and 8 exhibited an increase in Beta Lactam resistance gene abundance following amox/clav treatment (Figure 2). Concurrently, subject 8 exhibited a bloom in Proteobacteria, but post-auto FMT, subject 8 exhibited a return to pre-antibiotic conditions (albeit punctuated by fluctuations in Actinobacteria and Bacteroidetes).

Description: Macintosh HD:Users:christopherbulow:Desktop:All_FMT_Lahey_unBlind_v2.png

Conclusion: The most dramatic change in response to amox/clav observed was a Proteobacteria bloom in one subject associated with a surge in resistance gene abundance; however, restoration of the microbiome occurred following auto FMT. Additionally, amox/clav treatment led to increased Bacteroidetes abundance in some subjects (5/10); this resolved after saline or FMT enema. In other cases, little change in species composition (4/10) or resistance gene content following antibiotic treatment was observed (8/10).

Christopher Bulow, BA1, Amy Langdon, BA1, Tiffany Hink, BS2, Meghan Wallace, BS3, Kimberly Reske, MPH4, Xiaoqing Sun, MS1, Jennie H. Kwon, DO, MSCI4, Carey-Ann D. Burnham, PhD5, Gautam Dantas, PhD1 and Erik R. Dubberke, MD, MSPH, FIDSA, FSHEA6, (1)Washington University in St. Louis, St. Louis, MO, (2)Infectious Diseases, Washington University School of Medicine, St Louis, MO, (3)Pathology & Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO, (4)Infectious Diseases, Washington University School of Medicine, St. Louis, MO, (5)Pathology & Immunology, Washington University, St. Louis, MO, (6)Washington University School of Medicine, St. Louis, MO

Disclosures:

C. Bulow, None

A. Langdon, None

T. Hink, None

M. Wallace, None

K. Reske, None

X. Sun, None

J. H. Kwon, None

C. A. D. Burnham, None

G. Dantas, None

E. R. Dubberke, Rebiotix Inc.: Investigator and Scientific Advisor , Consulting fee and Research support
Merck: Consultant and Investigator , Consulting fee and Research support
Sanofi Pasteur: Consultant and Grant Investigator , Consulting fee and Grant recipient
Summitt: Consultant , Consulting fee

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