Fecal microbiota transplantation for carbapenem-resistant Pseudomonas spp. colonization in hematology patients: long-term real-world data.

OBJECTIVES

Colonization with carbapenem-resistant Pseudomonas spp (CRP) contributes to infections and high mortality. Fecal microbiota transplantation (FMT) offers a strategy for eradicating multidrug-resistant organisms, but experience on CRP decolonization in immunocompromised patients is meagre.

DESIGNS AND

METHODS

A single-center retrospective study of gastroscopic FMT in CRP-positive hematological patients. The primary objective was decolonization. Short and long-term post-FMT CRP-related infectious complications were evaluated.

RESULTS

By April 30, 2025, 14 patients (5 ALL, 5 AML, 2 MDS, 1 APL, 1 NHL) were enrolled; 8 had received allo-HCT. With a median follow-up of 16 months (1.45-26), decolonization was achieved in 10 in a median of 14 days (9-34) and was durable in 6. Eradication failure occurred in 4 due to persistence and 4 due to recurrence. Median time to recolonization was 83 (32-173). 9 patients experienced CRP-related infections following FMT: bloodstream infections (BSI) 67%, soft tissue 56%, gastrointestinal 56%, urinary tract 33%, pneumonia 22%, septic shock 22%. A total of 7 died; due to infections in 6, with CRP responsible in 5. No severe adverse events of FMT were reported.

CONCLUSIONS

FMT demonstrates safety and efficacy in early decolonization of CRP. In failure, CRP-related infections remain a leading cause of mortality.