Oral 72 Fresh, Frozen, or Lyophilized Fecal Microbiota Transplantation (FMT) for Multiple Recurrent C. difficile Infection (CDI)
Author Insight from Herbert L. DuPont, MD and Zhi-Dong Jiang, MD, University of Texas SPH, Houston
What’s new here and important for clinicians?
Background: Fecal microbiota transplantation (FMT) was introduced with the first reported case in 1958 by Eiseman et al. Over the subsequent 55 years, promising reports of FMT have suggested a ~90% clinical cure rate for multiply recurrent C. difficile infection (CDI) (≥ 3 bouts). These results indicate that FMT for recurrent CDI is significantly superior to those with antimicrobial therapy. Using fresh donor stool has its practical limitations, such as difficulty in stool preparation considering timeliness of collection and administration and standardization of donor stool. It has been proposed to use more convenient frozen fecal microbial extracts in the transplantation.
Our Study: We investigated the efficacy of fresh, frozen or lyophilized (freeze-dried) FMT from the same donors via colonoscopy in patients with recurrent CDI. We determined microbiota from donor FMT prior to administration of fresh, frozen and lyophilized material as well as stools from corresponding recipients, before FMT, 7, 14 and 30 days after FMT.We found equivalent success rates in FMT in the three methods of handling donor stools and found in FMT recipients by the three forms of FMT dramatic shifts in fecal flora with a decrease in Proteobacteria (from 62% to 7%) and an increase in Firmicutes (from 27% to 48%) and Bacteroidetes (from 0% to 25%). An increase in Verrucomicrobia driven by Akkermansia spp. was also observed between samples collected before and after FMT (0.054% vs. 12.12%, respectively) demonstrating an increase in mucosal-associated bacteria.
Conclusions: First, showing frozen FMT is as effective as fresh in the same donor provides evidence that the more convenient frozen fecal flora can be used routinely in FMT management of patients with recurrent CDI. Secondly, since lyophilized FMT is effective in treating recurrent CDI it should be possible to deliver powder form of the product orally in capsules to recipients with recurrent CDI and to explore the value of easily administered oral FMT in other indications such as inflammatory bowel disease.
What do patients need to know?
The diversity of colonic bacteria is responsible for general health. When a person takes multiple courses of antibiotics the diversity of bacterial species is reduced rendering the patient susceptible to disease-producing bacteria like C. difficile. When recurrent bouts of CDI occur the additional antibiotics given further reduce the flora diversity. The most effective treatment is to recolonize the colon with normal flora from a healthy donor. Being able to deliver FMT by thawing stored frozen bacteria makes FMT more convenient and less expensive. Being able to give the bacteria by capsule form makes it not only cheaper but more convenient for patients.
Herbert L. DuPont, MD
Zhi-Dong Jiang, MD
P939 Safety Outcomes After Fecal Microbiota Transplantation (FMT) For C. difficile Infection (CDI)
P454 Outcomes of Fecal Microbiota Transplantation for Clostridium difficile Infection in Patients With Inflammatory Bowel Disease
Oral 71 C. difficile Associated Risk of Death Score (CARDS): A Novel Risk Score to Predict Mortality Among Hospitalized Patients With C. difficile Infection
P1639 Fecal Microbiota Transplant for Treatment of Refractory C. difficile Colitis: Long-Term Follow-Up of 58 Patients
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