Fatal Aspiration Pneumonia as a Complication of Fecal Microbiota Transplant

Baxter, M.; Ahmad, Tariq; Colville, A.; Sheridan, Ray

doi:10.1093/cid/civ247

Cited by 106 publications

(98 citation statements)

References 4 publications

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“…Aspiration pneumonia due to nausea and vomiting by a nasogastric or nasojejunal tube has been reported 157 68 Fever has been observed both after via-upper GI and (less frequently) after via-colonoscopy infusion 3855 58 67 68 In the study by Moayyedi et al ,15 rectal abscesses after via-enemas infusion of faeces or placebo were reported in patients with UC.…”

Section: Resultsmentioning

confidence: 99%

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European consensus conference on faecal microbiota transplantation in clinical practice

Cammarota

Ianiro

Tilg

et al. 2017

Gut

875

848

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Faecal microbiota transplantation (FMT) is an important therapeutic option for Clostridium difficile infection. Promising findings suggest that FMT may play a role also in the management of other disorders associated with the alteration of gut microbiota. Although the health community is assessing FMT with renewed interest and patients are becoming more aware, there are technical and logistical issues in establishing such a non-standardised treatment into the clinical practice with safety and proper governance. In view of this, an evidence-based recommendation is needed to drive the practical implementation of FMT. In this European Consensus Conference, 28 experts from 10 countries collaborated, in separate working groups and through an evidence-based process, to provide statements on the following key issues: FMT indications; donor selection; preparation of faecal material; clinical management and faecal delivery and basic requirements for implementing an FMT centre. Statements developed by each working group were evaluated and voted by all members, first through an electronic Delphi process, and then in a plenary consensus conference. The recommendations were released according to best available evidence, in order to act as guidance for physicians who plan to implement FMT, aiming at supporting the broad availability of the procedure, discussing other issues relevant to FMT and promoting future clinical research in the area of gut microbiota manipulation. This consensus report strongly recommends the implementation of FMT centres for the treatment of C. difficile infection as well as traces the guidelines of technicality, regulatory, administrative and laboratory requirements.

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Section: Resultsmentioning

confidence: 99%

“…57 68 Fever has been observed both after via-upper GI and (less frequently) after via-colonoscopy infusion 3855 58 67 68 In the study by Moayyedi et al ,15 rectal abscesses after via-enemas infusion of faeces or placebo were reported in patients with UC. However, perianal disease in UC is also known to occur regardless of FMT 69…”

Section: Resultsmentioning

confidence: 99%

European consensus conference on faecal microbiota transplantation in clinical practice

Cammarota

Ianiro

Tilg

et al. 2017

Gut

875

848

View full text Add to dashboard Cite

show abstract

“…However, the working group expressed concerns regarding the risk of regurgitation and aspiration if large volumes of FMT are administered to the upper GI tract, and also discussed cases in which this has been described with adverse outcomes 80. This included a reported death from aspiration, after 100–150 mL of FMT was delivered by enteroscope into the distal duodenum under general anaesthetic as attempted treatment for recurrent CDI 133. A further report described a case of fatal aspiration pneumonitis likely related to a 500 mL FMT via nasoduodenal tube; this patient had a swallowing disorder following oropharyngeal radiation after surgical removal of a maxillary carcinoma 2 years previously 77.…”

Section: Rationale For Recommendationsmentioning

confidence: 99%

The use of faecal microbiota transplant as treatment for recurrent or refractoryClostridium difficileinfection and other potential indications: joint British Society of Gastroenterology (BSG) and Healthcare Infection Society (HIS) guidelines

Mullish

Quraishi

Segal

et al. 2018

Gut

273

205

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Interest in the therapeutic potential of faecal microbiota transplant (FMT) has been increasing globally in recent years, particularly as a result of randomised studies in which it has been used as an intervention. The main focus of these studies has been the treatment of recurrent or refractory infection (CDI), but there is also an emerging evidence base regarding potential applications in non-CDI settings. The key clinical stakeholders for the provision and governance of FMT services in the UK have tended to be in two major specialty areas: gastroenterology and microbiology/infectious diseases. While the National Institute for Health and Care Excellence (NICE) guidance (2014) for use of FMT for recurrent or refractory CDI has become accepted in the UK, clear evidence-based UK guidelines for FMT have been lacking. This resulted in discussions between the British Society of Gastroenterology (BSG) and Healthcare Infection Society (HIS), and a joint BSG/HIS FMT working group was established. This guideline document is the culmination of that joint dialogue.

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“…Furthermore, the optimal method for administering FMT has not been determined. Evidence suggests that colonoscopic delivery has advantages in terms of efficacy (9), safety (13), and patient acceptance and tolerability (14) compared with administration via the nasoenteric route. We therefore performed a double-blind, randomized, controlled study of colonoscopic FMT for treatment of recurrent CDI.…”

mentioning

confidence: 99%

Effect of Fecal Microbiota Transplantation on Recurrence in Multiply Recurrent Clostridium difficile Infection

Kelly

Khoruts

Staley³

et al. 2016

Ann Intern Med

534

423

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Background To date, evidence for the efficacy of fecal microbiota transplantation (FMT) in recurrent Clostridium difficile infection (CDI) has been limited to case series and open-label clinical trials. Objective To determine the efficacy and safety of FMT for treatment of recurrent CDI. Design Randomized, controlled, double-blind clinical trial. (ClinicalTrials.gov: NCT01703494) Setting Two academic medical centers. Patients 46 patients who had 3 or more recurrences of CDI and received a full course of vancomycin for their most recent acute episode. Intervention Fecal microbiota transplantation with donor stool (heterologous) or patient’s own stool (autologous) administered by colonoscopy. Measurements The primary end point was resolution of diarrhea without the need for further anti-CDI therapy during the 8-week follow-up. Safety data were compared between treatment groups via review of adverse events (AEs), serious AEs (SAEs), and new medical conditions for 6 months after FMT. Fecal microbiota analyses were performed on patients’ stool before and after FMT and also on donors’ stool. Results In the intention-to-treat analysis, 20 of 22 patients (90.9%) in the donor FMT group achieved clinical cure compared with 15 of 24 (62.5%) in the autologous FMT group (P = 0.042). Resolution after autologous FMT differed by site (9 of 10 vs. 6 of 14 [P = 0.033]). All 9 patients who developed recurrent CDI after autologous FMT were free of further CDI after subsequent donor FMT. There were no SAEs related to FMT. Donor FMT restored gut bacterial community diversity and composition to resemble that of healthy donors. Limitation The study included only patients who had 3 or more recurrences and excluded those who were immunocompromised and aged 75 years or older. Conclusion Donor stool administered via colonoscopy seemed safe and was more efficacious than autologous FMT in preventing further CDI episodes. Primary Funding Source National Institute of Diabetes and Digestive and Kidney Diseases.

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Fatal Aspiration Pneumonia as a Complication of Fecal Microbiota Transplant

Cited by 106 publications

References 4 publications

European consensus conference on faecal microbiota transplantation in clinical practice

European consensus conference on faecal microbiota transplantation in clinical practice

The use of faecal microbiota transplant as treatment for recurrent or refractoryClostridium difficileinfection and other potential indications: joint British Society of Gastroenterology (BSG) and Healthcare Infection Society (HIS) guidelines

Effect of Fecal Microbiota Transplantation on Recurrence in Multiply Recurrent Clostridium difficile Infection

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