Do Specific Bacteria Drive Clinical Cure in Fecal Microbiota Transplantation for Clostridium Difficile Infection?: Clinical, Microbial and Metabolomic Characterization of Universal FMT Donors

Budree, Shrish; Wong, Wing Fei; Tu, Emilee; Rao, Sanjay; Allegretti, Jessica R.; Fischer, Monika; Kelly, Colleen R.; Osman, Majdi; Smith, Mark; Kassam, Zain

doi:10.1016/s0016-5085(17)31428-2

Cited by 7 publications

(6 citation statements)

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“…Other studies have identified Charlson Comorbidity Index, 20 the severity of CDI, 21 , 22 previous (CDI) hospitalisation, 22 , 23 inpatient status, 22 surgery, 23 female sex 23 and older age 24 to predict recurrence after FMT. We did not recognize donor‐related factors contributing to FMT outcome, confirming previous reports 25–27 . The majority of patients with post‐FMT CDI were cured with antibiotic treatment, suggesting that this should be considered a different entity compared to the antibiotic resistant episodes prior to FMT.…”

Section: Discussionsupporting

confidence: 79%

“…We did not recognize donor-related factors contributing to FMT outcome, confirming previous reports. 25 – 27 The majority of patients with post-FMT CDI were cured with antibiotic treatment, suggesting that this should be considered a different entity compared to the antibiotic resistant episodes prior to FMT. This could be explained as an FMT-mediated gut microbiota reset, which renders patient less susceptible to rCDI after treatment with antibiotics alone.…”

Section: Discussionmentioning

confidence: 99%

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Faecal microbiota transplantation for Clostridioides difficile infection: Four years’ experience of the Netherlands Donor Feces Bank

et al. 2020

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Background The Netherlands Donor Feces Bank provides standardized ready-to-use donor faecal suspensions for faecal microbiota transplantation treatment of patients with recurrent Clostridioides difficile infection. Objective The purpose of this study was evaluation of safety, feasibility and outcome of faecal microbiota transplantation facilitated by a national stool bank. Methods The methods used included: observational cohort study of donors and recipients of faecal suspensions; assessment of donor screening and patient selection performed by an expert panel of medical microbiologists, gastroenterologists and infectious disease specialists; and patient outcome evaluated at different timepoints after faecal microbiota transplantation. Results Of 871 volunteers who registered as a potential faeces donor, 16 (2%) became active donors. Nine donors stopped or were excluded after a mean donation period of 5.7 months. In 2016–2019, 47 (27%) of 176 requests for faecal microbiota transplantations were deemed not indicated by the expert panel. In total, 129 patients with recurrent C. difficile infection were treated with 143 faecal suspensions in 40 different hospitals. The cure rate at two months after a single infusion was 89% (107/120). Of 84 patients, long-term follow-up (median 42 weeks) was available and sustained cure was achieved in 61 (73%). Early C. difficile infection relapses (within two months after faecal microbiota transplantation) and late recurrences (after more than two months) occurred more frequently in patients who received non- C. difficile antibiotics within three weeks after faecal microbiota transplantation and in moderately to severely immunocompromised patients. Of 21 patients with C. difficile infection after faecal microbiota transplantation, 14 were cured with anti- C. difficile antibiotics and seven with a second transplantation. No faecal microbiota transplantation-related serious adverse events were observed, but gastro-intestinal complaints (nausea, abdominal pain or diarrhoea) persisted in 32% of the treated patients at long-term follow-up. Conclusion Faecal suspensions provided by a centralized stool bank, supported by a multidisciplinary expert team, resulted in effective, appropriate and safe application of faecal microbiota transplantation for recurrent C. difficile infection. Level of evidence Level II, prospective cohort study

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Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Faecal microbiota transplantation for Clostridioides difficile infection: Four years’ experience of the Netherlands Donor Feces Bank

et al. 2020

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“…Second, the requirement that donations be passed on-site limits the bank’s donor pool to one metropolitan area. Although stool from any donor passing the stool bank’s screens appears equally efficacious for treating C. difficile infection ( Budree et al., 2017a ; Budree et al., 2017b ; Budree et al., 2018 ; Osman et al., 2018 ; Olesen, 2020), the same may not hold true for other diseases. For example, it may or may not be important for donors and recipients to be geographically “matched” to ensure maximally safe and effective FMT ( Yatsunenko et al., 2012 ; Gaulke and Sharpton, 2018 ; Pasolli et al., 2019 ).…”

Section: Discussionmentioning

confidence: 99%

Stool Banking for Fecal Microbiota Transplantation: Methods and Operations at a Large Stool Bank

Zaman

Ramakrishna

Olesen

2021

Front. Cell. Infect. Microbiol.

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ObjectivesFecal microbiota transplantation (FMT) is a recommended therapy for recurrent Clostridioides difficile infection and is being investigated as a potential therapy for dozens of microbiota-mediated indications. Stool banks centralize FMT donor screening and FMT material preparation with the goal of expanding access to FMT material while simultaneously improving its safety, quality, and convenience. Although there are published consensuses on donor screening guidelines, there are few reports about the implementation of those guidelines in functioning stool banks.MethodsTo help inform consensus standards with data gathered from real-world settings and, in turn, to improve patient care, here we describe the general methodology used in 2018 by OpenBiome, a large stool bank, and its outputs in that year.ResultsIn 2018, the stool bank received 7,536 stool donations from 210 donors, a daily average of 20.6 donations, and processed 4,271 of those donations into FMT preparations. The median time a screened and enrolled stool donor actively donated stool was 5.8 months. The median time between the manufacture of an FMT preparation and its shipment to a hospital or physician was 8.9 months. Half of the stool bank’s partner hospitals and physicians ordered an average of 0.75 or fewer FMT preparations per month.ConclusionsFurther knowledge sharing should help inform refinements of stool banking guidelines and best practices.

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“…Tito et al [ 4 ] found that the most common subtypes in Europe—ST1, ST2, ST3, and ST4—were all associated with higher diversity, though ST1 and ST3 (which were identified in our study) had lower diversity increases than ST2 and ST4. For FMT treatment of rCDI, super donors have not been detected [ 34 , 35 ] and all donors display a high cure rate, of around 85% [ 21 ]. The role of super-donors could play a more significant role in possible future FMT indications other than rCDI, such as ulcerative colitis, metabolic syndrome, the eradication of multidrug resistant organisms, or hepatic encephalopathy [ 4 , 36 , 37 ].…”

Section: Discussionmentioning

confidence: 99%

Human Transmission of Blastocystis by Fecal Microbiota Transplantation Without Development of Gastrointestinal Symptoms in Recipients

Gool

Sanders

Bart

et al. 2019

Clinical Infectious Diseases

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Background Patients with multiple recurrent Clostridioides difficile infections (rCDI) are treated with fecal microbiota transplantation (FMT), using feces provided by healthy donors. Blastocystis colonization of donors is considered an exclusion criterion, whereas its pathogenicity is still under debate. Methods The introduction of molecular screening for Blastocystis sp. at our stool bank identified 2 donors with prior negative microscopies but positive polymerase chain reactions (PCRs). Potential transmission of Blastocystis sp. to patients was assessed on 16 fecal patient samples, pre- and post-FMT, by PCR and subtype (ST) analyses. In addition, clinical outcomes for the treatment of rCDI (n = 31), as well as the development of gastrointestinal symptoms, were assessed. Results There was 1 donor who carried Blastocystis ST1, and the other contained ST3. All patients tested negative for Blastocystis prior to FMT. With a median diagnosis at 20.5 days after FMT, 8 of 16 (50%) patients developed intestinal colonization with Blastocystis, with identical ST sequences as their respective donors. Blastocystis-containing fecal suspensions were used to treat 31 rCDI patients, with an FMT success rate of 84%. This success rate was not statistically different from patients transferred with Blastocystis sp.–negative donor feces (93%, 76/82). Patients transferred with Blastocystis sp.–positive donor feces did not report any significant differences in bowel complaints in the first week, after 3 weeks, or in the months following FMT. Conclusions We demonstrated the first transmission of Blastocystis ST1 and ST3 from donors to patients by FMT. This did not result in gastrointestinal symptomatology or have any significant effect on rCDI treatment outcomes.

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Do Specific Bacteria Drive Clinical Cure in Fecal Microbiota Transplantation for Clostridium Difficile Infection?: Clinical, Microbial and Metabolomic Characterization of Universal FMT Donors

Cited by 7 publications

References 0 publications

Faecal microbiota transplantation for Clostridioides difficile infection: Four years’ experience of the Netherlands Donor Feces Bank

Faecal microbiota transplantation for Clostridioides difficile infection: Four years’ experience of the Netherlands Donor Feces Bank

Stool Banking for Fecal Microbiota Transplantation: Methods and Operations at a Large Stool Bank

Human Transmission of Blastocystis by Fecal Microbiota Transplantation Without Development of Gastrointestinal Symptoms in Recipients

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