Grant: Project Grant

Antimicrobial resistance is a global threat to public health. The Canadian government recently made antimicrobial resistance a nationwide health priority (Antimicrobial Resistance and Use in Canada: A Federal Framework for Action). Kidney transplant patients are at especially high-risk of developing infections caused by multidrug-resistant bacteria, so-called 'super-bugs'. These drug-resistant infections are hard to treat, result in longer hospital stays, and lead to more deaths and higher medical costs. The source of these 'super-bugs' is often the patient's own gut, where they can remain until escaping to cause infection. Current approaches to eliminating resistant bacteria from the gut do not work very well and can sometimes lead to an increase in resistant bacteria. Emerging evidence suggests that fecal microbiota transplantation (FMT), otherwise known as a 'poop' transplant, may be an effective and innovative approach to eradicating multidrug-resistant bacteria from the gut before they can cause infection. FMT involves the infusion of fully screened, healthy donor stool into a patient. FMT is already known to be a safe and effective way to remove Clostridium difficile, a cause of hospital-associated diarrhea, from infected patients. In this randomized controlled trial, we will test the efficacy of FMT via enema to eliminate highly resistant bacteria from the intestinal tract of kidney transplant patients. We will also examine (1) FMT safety; (2) how long patients remain decolonized; (3) if there are fewer infections after FMT; and (4) how FMT might work. Our research team has obtained all the necessary ethics and Health Canada approvals and started study recruitment. Ideally, FMT donor feces will be replaced by a well-defined community of bacteria that is just as effective as FMT. Vedanta Biosciences, our industry partner, will work with us to develop a transformative microbial therapy to prevent carriage and infection by highly drug-resistant 'super-bugs'.