FECAL MICROBIOTA TRANSPLANTATION FOR DECOLONIZATION OF MULTIDRUG-RESISTANT ORGANISMS:AN EMERGING STRATEGY AGAINST ANTIMICROBIAL RESISTANCE

Abstract
Antimicrobial resistance has traditionally been confronted with escalating pharmacologic
force, yet the gut, which is a primary ecological reservoir of multidrug-resistant
organisms(MDROs) has remained an underexploited therapeutic target. Conventional
decolonization strategies largely antibiotic-driven often provide transient benefits while
reinforcing resistance.This review explores the evolving role of Fecal Microbiota Transplant
(FMT) as a therapeutic strategy for MDRO decolonization, synthesizing evidence from
clinical trials, observational studies and mechanistic microbiome research. Comparative
analyses highlight the limitations of traditional decolonization approaches and position FMT
as a potentially paradigm-shifting alternative. FMT, long established for recurrent
Clostridioides difficile infection, is now being explored for its ability to restore colonization
resistance and disrupt intestinal dominance of MDROs such as Carbapenem-resistant
Enterobacteriaceae, extended-spectrum β-lactamase- producing organisms and Vancomycinresistant Enterococcus. Emerging clinical evidence suggests that FMT can reduce MDRO
carriage, lower resistome burden and potentially decrease infection recurrence by
reconstituting microbial diversity and metabolic functionality. However, questions
surrounding durability, safety, optimal patient selection and standardization continue to
challenge widespread implementation. This review synthesized current mechanistic insights
and clinical evidence supporting FMT for MDRO decolonization, critically compares it with
conventional strategies and examines key safety and durability considerations. This further
explore future directions, including precision microbiome therapeutics, defined microbial
consortia and integration with antimicrobial stewardship programs. By reframing MDRO
decolonization through an ecological system, this article highlights how microbiome
restoration may shift the paradigm from pathogen eradication to ecosystem rehabilitation.
Understanding whether FMT represents a transitional solution or a cornerstone in the fight
against antimicrobial resistance remains a pressing and provocative question for modern
medicine.
Keywords: Fecal microbiota transplantation, multidrug-resistant organism, antimicrobial
resistance, colonization resistance, antimicrobial stewardship.