Faecal microbiota transplantation in Clostridioides difficile infection: real-life experience from an academic Italian hospital

Abstract

Background: Faecal microbiota transplantation (FMT) is a reasonable therapeutic option for the treatment of Clostridioides difficile infection (CDI) recurrent and refractory (RCDI) to therapy, but little evidence on the long-term impact of this therapy is currently available in the literature. The aim of this study was to evaluate the efficacy and safety of FMT in recurrent and refractory CDI and the modifications of the recipient’s gut microbiota in the medium–long term. Methods: This prospective study collects the clinical and laboratory data of RCDI patients treated with FMT by colonoscopy from February 2016 to October 2019. Stool samples for metagenomic analysis were collected pre-FMT at 1 week and at 6 and 12–24 months post-FMT. Results: In the study period, 20 FMT procedures were performed on 19 patients. Overall, FMT was effective in 85% of treated patients. No serious adverse event was recorded. In the medium- to long-term follow up, a newly diagnosed case of collagenous colitis was observed. Post-FMT, significant changes in microbiota were observed, characterised by the transition from a low- to a greater-diversity profile. Therefore, FMT restores eubiosis and maintains it over time. Conclusion: FMT is a safe and effective treatment option in RCDI patients. This procedure induces profound microbiota changes that explain its high clinical efficacy.

Fecal microbiota transplantation for recurrentClostridioides difficile, safety, and pitfalls

“…15 The study reported significant change in microbiota toward eubiotic status at all time points analyzed. 15 In particular, there was a decrease in protobacteria which is related to dysbiosis and normalization of Faecalibacterium parusnitizii 1 year post FMT again favoring eubiotic state achieved by FMT. 15 When compared with standard oral antibiotic treatment, FMT has demonstrated survival benefit.…”

“… 13 , 14 A prospective study conducted by Barberio et al analyzed stool samples for metagenomic analysis pre- and post-FMT at 1 week and 6 and 12–24 months. 15 The study reported significant change in microbiota toward eubiotic status at all time points analyzed. 15 In particular, there was a decrease in protobacteria which is related to dysbiosis and normalization of Faecalibacterium parusnitizii 1 year post FMT again favoring eubiotic state achieved by FMT.…”

“…15 In particular, there was a decrease in protobacteria which is related to dysbiosis and normalization of Faecalibacterium parusnitizii 1 year post FMT again favoring eubiotic state achieved by FMT. 15 When compared with standard oral antibiotic treatment, FMT has demonstrated survival benefit. A prospective cohort study conducted by Ianiro et al analyzed 290 rCDI patients, of which 109 received FMT and 181 received antibiotics (pulsed oral vancomycin, oral metronidazole plus pulsed oral vancomycin, fidaxomicin, or oral metronidazole).…”

Fecal microbiota transplantation in human metabolic diseases: From a murky past to a bright future?

“…A recent study based on deep analysis and mouse studies provided support for the hypothesis that specifically bile salt hydrolase-producing bacteria contribute to the success of the FMT in recurrent C. difficile infections, as this enzyme can degrade taurocholic acid, a potent C. difficile germinant (Mullish et al, 2019). Of interest, some reports indicate that subsequent disturbances of FMT-treated patients, such as those evoked by the use of antibiotics, may compromise the microbiota and result in a relapse with non-C. difficile-dependent colitis that subsequently needed to be corrected by a new FMT (Barberio et al, 2020;Satokari et al, 2014). This situation is reminiscent of a non-resilient microbiome in a metastable equilibrium that can return to an alternative stable state associated with inflammation.…”

Nutritional Status and the Critically Ill Patient: Gut Microbiota and Immuno-Nutrition in I.C.U. at the Time of SARS-COV 2 Pandemic

“…FMT resembles the most direct approach to restore gut dysbiosis currently available in clinical and experimental practice. It consists in the infusion of feces from a healthy donor directly to the gastrointestinal tract of the recipient, restoring both the complexity and diversity of the gut microbiota [46][47][48]. From a bench point of view, FMT has also been associated with a reduction of antimicrobial resistance genes in stool microbiota [49].…”