Michael Woodworth, an associate professor in Emory's Department of Medicine, is fighting a long-term battle to protect people against one of the greatest challenges in modern medicine: multidrug-resistant bacteria, which are resistant to multiple types of antibiotics. These “superbugs” cause infections that can be extremely difficult to treat. In some cases, they are impossible to cure with available medications, putting patients at serious risk.
Emory Prof. Michael Woodworth
In their latest research, they tested whether this approach was safe and acceptable to patients in a long-term acute care hospital (LTACH). These specialized facilities provide extended, complex care for patients recovering from critical illness, prolonged ventilation, or complex wounds. “By the time patients arrive to a long-term acute care hospital, many have had several courses of antibiotics and procedures,” Woodworth explains. “More than 70 or 80% of patients admitted to these facilities may carry one or more multidrug-resistant organisms.” This means that multidrug-resistant bacteria are a daily challenge for LTACHs, which makes them important places to study new interventions that could reduce these infections and prevent their spread.
Encouraging results for long term care patients treated with microbiota
In a new clinical study called Sentinel REACT, published in JAMA Network Open, Woodworth and his collaborators at the Prevention Epicenter of Emory and Collaborating Healthcare Facilities (PEACH) collected gut microbiota from thoroughly screened healthy donors. They administered this treatment — either through an enema or a feeding tube — to 10 long-term care patients who had multidrug-resistant organisms in their gut.
Patients who received the microbiota treatment in Sentinel REACT had fewer bloodstream infections and needed fewer days of antibiotic therapy compared to control patients, although these differences were not statistically significant due to the small sample size. “Sentinel REACT suggests that microbiota treatments are feasible and did not appear to cause serious side effects,” says Woodworth. “This could expand the public health toolkit to address antibiotic resistance in facilities facing challenges with antibiotic resistance.”
This small pilot study is a first step, Woodworth says, but a promising one. He is now following up with a larger study. “We were surprised by the finding of fewer bloodstream infections among microbiota treated participants,” he says. “We’re currently testing a higher dose in a multi-center study in collaboration with other CDC-funded Epicenter program sites at the University of Pennsylvania and Rush Medical College, where we aim to enroll more participants and randomize them to microbiota therapy or control. We will test if higher doses improve decolonization rates, reduce infections or both.”
If the microbiota treatment is effective, it could offer a much-needed approach to prevent infection and could change the way health care providers protect patients in long-term care.
Ultimately, Woodworth would like to see microbiota treatments that are more widely accessible that can be given to anyone faced with a threat to their microbiota. “It is a disservice to patients to think of these therapies as only being useful in extreme cases,” he says. “Many health conditions are linked to the microbiome. To reach a future where we can improve microbiome health in routine care, we need to develop products that can be produced and administered safely at scale.”
In the medium term, Woodworth is interested in other ways to support growth of these beneficial bacteria through lower cost and simpler to implement pragmatic interventions like dietary supplementation.
“We will know best how to tailor dietary interventions when we compare them or even combine them directly with microbiota treatments in clinical trials,” he says. “More work is needed but this study is one step closer to treatments that can be routinely used for microbiome health.”