A randomized, sham-controlled study published in JAMA Internal Medicine found that a single fecal microbiota transplantation (FMT) session did not significantly eliminate multidrug-resistant organisms (MDROs) or reduce antimicrobial resistance genes in patients with gastrointestinal diseases such as pancreatitis and cirrhosis. Four weeks after treatment, MDRO decolonization rates were nearly identical between the FMT and sham groups (31% vs. 30.4%), suggesting that one FMT procedure alone is insufficient to eradicate persistent drug-resistant bacteria.
Despite failing to meet its primary endpoints, FMT produced meaningful changes in the gut microbiome. Gene-sequencing analyses showed increased microbial diversity and enrichment of beneficial short-chain fatty acid–producing bacteria, including Dorea, Holdemanella, Lachnospira, Agathobacter, and Eubacterium. These microbial shifts, which were not seen in the sham group, suggest that FMT can promote a healthier gut ecosystem even if it does not immediately translate into MDRO clearance.