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Antibiotic‐Associated Disruption of Microbiota Composition and Function in Cirrhosis Is Restored by Fecal Transplant
Author(s) -
Bajaj Jasmohan S.,
Kakiyama Genta,
Savidge Tor,
Takei Hajime,
Kassam Zain A.,
Fagan Andrew,
Gavis Edith A.,
Pandak William M.,
Nittono Hiroshi,
Hylemon Phillip B.,
Boonma Prapaporn,
Haag Anthony,
Heuman Douglas M.,
Fuchs Michael,
John Binu,
Sikaroodi Masoumeh,
Gillevet Patrick M.
Publication year - 2018
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.30037
Subject(s) - rifaximin , lachnospiraceae , antibiotics , medicine , lactulose , gastroenterology , cirrhosis , gut flora , feces , hepatology , microbiology and biotechnology , biology , immunology , bacteria , genetics , 16s ribosomal rna , firmicutes
Patients with cirrhosis are often exposed to antibiotics that can lead to resistance and fungal overgrowth. The role of fecal microbial transplant (FMT) in restoring gut microbial function is unclear in cirrhosis. In a Food and Drug Administration–monitored phase 1 clinical safety trial, patients with decompensated cirrhosis on standard therapies (lactulose and rifaximin) were randomized to standard‐of‐care (SOC, no antibiotics/FMT) or 5 days of broad‐spectrum antibiotics followed by FMT from a donor enriched in Lachnospiraceae and Ruminococcaceae. Microbial composition (diversity, family‐level relative abundances), function (fecal bile acid [BA] deconjugation, 7α‐dehydroxylation, short‐chain fatty acids [SCFAs]), and correlations between Lachnospiraceae, Ruminococcaceae, and clinical variables were analyzed at baseline, postantibiotics, and 15 days post‐FMT. FMT was well tolerated. Postantibiotics, there was a reduced microbial diversity and autochthonous taxa relative abundance. This was associated with an altered fecal SCFA and BA profile. Correlation linkage changes from beneficial at baseline to negative after antibiotics. All of these parameters became statistically similar post‐FMT to baseline levels. No changes were seen in the SOC group. Conclusion: In patients with advanced cirrhosis on lactulose and rifaximin, FMT restored antibiotic‐associated disruption in microbial diversity and function. (H epatology 2018; 00:000‐000).