Fecal Microbiota Transplantation for multidrug-resistant organism: Efficacy and Response prediction

•Fecal microbiota transplantation is an effective way to decolonize CPE, VRE, and both CPE and VRE.•The efficacy of fecal microbiota transplantation is significantly affected by MDRO types.•Fecal microbiota transplantation induces microbiota richness and biodiversity into the recipients’ gut.•Microbiota analysis before FMT may predict its effectiveness. The increasing prevalence of multidrug-resistant microorganisms (MDRO) is increasing the frequency of poor clinical outcomes, prolonging hospitalizations, and raising healthcare costs. This study evaluated the eradication efficacy of fecal microbiota transplantation (FMT) and identified microbial and functional biomarkers of MDRO decolonization. Fecal solution obtained from healthy unrelated donors was infused in the participants’ guts which had been colonized with carbapenemase-producing enterobacteriacea (CPE), vancomycin-resistant enterococci (VRE), or both CPE and VRE. Fecal samples from recipients were collected and microbiome changes before and after FMT were assessed. Twenty-four (68.6%) out of 35 patients were decolonized within one year of receiving FMT. Multivariate analysis showed that FMT (FMT: hazard ratio (HR) = 5.343, 95% confidence interval (CI) = 1.877-15.212, p = 0.002) and MDRO types (CPE: HR = 11.146, 95% CI = 2.420-51.340, p = 0.002; CPE/VRE: HR = 2.948, 95% CI = 1.200-7.246, p = 0.018; VRE served as the reference) were significant independent factors associated with time to decolonization. Microbiota analysis showed higher richness and biodiversity before FMT resulted in VRE decolonization. The species Clostridium ramosum and the genuses Anaerostipes and Eisenbergiella could serve as taxonomic biomarkers and K02017 could serve as a functional biomarker for VRE clearance. FMT is an effective way to decolonize MDRO and its effectiveness may be predicted by microbiome analysis.