Carbapenem-resistant Enterobacteriaceae is one of the three critical-priority antimicrobial-resistant threats in the latest 2017 WHO priority threat list and is a growing threat in Singapore with rising incidence since 2010. There are currently widely accepted clinical options for decolonizing carriers, creating strain on the healthcare system and restricting access to healthcare for a large number of patients.

In this project, we aim to test whether fecal microbiota transplantation (FMT) is effective in reducing the gut bacterial load of the two main forms of CREs: Cohort 1 -Carbapenem-producing Enterobacteriaceae (CPE); and Cohort 2 -Non-carbapenem carbapenem-resistant Enterobacteriaceae (NCP-CRE). Subjects will be followed using microbiome profiling including 16S and metagenomic sequencing, as well as culture-based approaches. Genomic data will be used to interrogate the mechanism as well as the dynamics of decolonization. In addition, we will test the specific hypothesis that CPE patients will be more effectively and rapidly decolonized by FMT, due to a stronger fitness trade-off in the absence of antibiotics. Results from this study will be used to scale up to larger cohorts.