Abstract
BACKGROUND: Rises in the prevalence of multi-drug-resistant organisms threaten patient safety globally. Vancomycin-resistant enterococci (VREs) and carbapenem-resistant Enterobacterales (CRE) are linked with prolonged hospitalisation, treatment failure, and increased mortality. Decolonisation strategies could reduce transmission and improve outcomes, but their efficacy and safety remain uncertain. This study systematically evaluates decolonisation protocols for VRE and CRE through a meta-analysis.
METHODS: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic review and meta-analysis were performed on studies using PubMed, ScienceDirect, Web of Science, and Scopus. Studies evaluating decolonisation protocols for VRE and CRE were included. Papers were assessed for risk of bias using the Risk of Bias 2 tool and Newcastle-Ottawa Scale. Meta-analyses were performed using RevMan, Cochrane, London, United Kingdom.
RESULTS: Sixteen studies with a total of 872 participants were included for meta-analysis. Faecal microbiota transplantation (FMT) significantly improved clearance of CRE (risk ratio [RR]: 2.01; 95% confidence interval [CI]: 1.27-3.18) and VRE (RR: 2.96, 95% CI: 1.60-5.47) compared with controls, with low to moderate heterogeneity. Selective digestive decontamination (SDD) significantly increased clearance of CRE (RR: 2.47, 95% CI: 1.32-4.63), but not VRE (RR: 1.52, 95% CI: 0.70-3.30). Adverse events were generally mild, but SDD was associated with increased antimicrobial resistance in several studies.
CONCLUSIONS: FMT and SDD are promising interventions for CRE decolonisation, with FMT also showing benefit in VRE. The durability of SDD effects appears limited, with significant risk of promoting resistance. Future studies should standardise endpoints, evaluate combination approaches, and explore bacteriophage therapy. We suggest implementing uniform terminology with 'provisional clearance' as a descriptor for eradication at 1 month post intervention and 'enduring clearance' following continuous eradication for 6 months.