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

Abstract

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

Determinants of community members’ willingness to donate stool for faecal microbiota transplantation

“…Individual bowel habits such as the frequency, timing, and duration of bowel movements (BM), as well as discomfort donating outside the home environment (e.g., at a collection facility), likely also impact logistics and donation willingness, but their impact has not been considered. Moreover, there is variability in stool collection procedures with some facilities allowing donors to collect stool at home and transport it to a facility [ 17 , 18 ], while others adhere to biosafety regulations that require stool collection to occur in a designated room at the facility [ 19 ]. As such, it is important to consider both home and in-centre donation.…”

Expert centres for faecal microbiota transplantation: The guarantee for safe and effective use of faecal transplants

“…[5][6][7] In this issue, Terveer et al present in great details the first four years' experience of the Netherlands Donor Feces Bank (NDFB) -a nationwide organisation that centralises faeces collection, reviews FMT requests and performs prospective long-term followup. 8 This work of great value embraces all aspects and difficulties that can be faced when performing FMT: from the complex task of selecting a donor to the need for long-term follow-up and risk factors associated with FMT failure.…”

Gut Microbiota Interaction with the Central Nervous System throughout Life

“…A more successful approach to cure C. difficile infection is suggested by the results of FMT [ 213 , 214 ]. FMT has been recommended with more than one recurrent severe episode of C. difficile infection [ 215 ] and it has been demonstrated that it cures nearly 100% of the patients [ 213 , 215 , 216 , 217 ].…”