Long-term durability and safety of fecal microbiota transplantation for recurrent or refractory Clostridioides difficile infection with or without antibiotic exposure

Lee, Christine H.; Chai, Jocelyn; Hammond, K.; Jeon, Seong Ran; Patel, Yogita; Goldeh, Christiana; Kim, Peter

doi:10.1007/s10096-019-03602-2

Cited by 17 publications

(23 citation statements)

References 22 publications

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“…Despite generally low rates of reported adverse events, the most limiting caveat about FMT using whole donor stool is the concern of longterm safety of the procedure. 77 By contrast, autologous transplantation circumvents the potential for transmission of both communicable and noncommunicable diseases, as well the transfer of yet to be discovered microbial drivers of disease present in the gut microbiota. Autologous FMT also reduces the potential for donor-recipient microbial-interactions/incompatibilities which have been shown to influence strain engraftment outcomes.…”

Section: Introductionmentioning

confidence: 99%

Autologous fecal microbiota transplantation for the treatment of inflammatory bowel disease

Basson

Zhou

Seo

et al. 2020

Translational Research

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The term autologous fecal microbiota transplantation (a-FMT) refers herein to the use of one's feces during a healthy state for later use to restore gut microbial communities after perturbations. Generally, heterologous fecal microbiota transplantation (h-FMT), where feces from a ''healthy" donor is transplanted into a person with illness, has been used to treat infectious diseases such as recurrent Clostridioides difficile infection (CDI), with cure rates of up to 90%. In humans, due to limited response to medicines, h-FMT has become a hallmark intervention to treat CDI. Extrapolating the benefits from CDI, h-FMT has been attempted in various diseases, including inflammatory bowel disease (IBD), but clinical response has been variable and less effective (ranging between 24% and 50%). Differences in h-FMT clinical response could be because CDI is caused by a Clostridial infection, whereas IBD is a complex, microbiome-driven immunological inflammatory disorder that presents predominantly within the gut wall of geneticallysusceptible hosts. FMT response variability could also be due to differences in microbiome composition between donors, recipients, and within individuals, which vary with diet, and environments, across regions. While donor selection has emerged as a key factor in FMT success, the use of heterologous donor stool still places the recipient at risk of exposure to infectious/pathogenic microorganisms. As an implementable solution, herein we review the available literature on a-FMT, and list some considerations on the benefits of a-FMT for IBD. (Translational Research 2020; 226:1À11) Abbreviation: a-FMT = autologous fecal microbiota transplantation; CD = Crohn's disease; CDI = Clostridium difficile infection; CI = Confidence interval; FMT = Fecal microbiota transplantation; hGM = human gut microbiota; h-FMT = heterologous fecal microbiota transplantation; IBD = inflammatory bowel disease; IBS = irritable bowel syndrome; RCT = randomized controlled trial; UC = ulcerative colitis

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Section: Introductionmentioning

confidence: 99%

Autologous fecal microbiota transplantation for the treatment of inflammatory bowel disease

Basson

Zhou

Seo

et al. 2020

Translational Research

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“…The long-term safety of FMT is not fully investigated. Results from patients with rCDI treated with FMT, which are often multi-morbid and frail, does not indicate long-term adverse events [ 54 , 57 ]. FMT to chronic pouchitis possibly requires several FMT treatments to achieve clinical remission similar to UC [ 18 , 45 , 46 , 48 , 58 ], whereas usually one FMT is sufficient to treat rCDI [ 59 ].…”

Section: Discussionmentioning

confidence: 99%

Fecal Microbiota Transplantation in the Treatment of Chronic Pouchitis: A Systematic Review

et al. 2020

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The objective was to evaluate available literature on treatment of chronic pouchitis with fecal microbiota transplantation (FMT) focusing on clinical outcomes, safety, and different approaches to FMT preparation and delivery. A systematic review of electronic databases was conducted using Medline, EMBASE, and the Cochrane Central Register of Controlled Trials Library from inception through April 2020. Human studies of all study types reporting results of FMT to treat chronic pouchitis were included. Nine studies, reporting FMT treatment of 69 patients with chronic pouchitis were found eligible for the review. Most studies were case series and cohort studies rated as having fair to poor quality due to high risk of bias and small sample size. Only one randomized controlled trial was included, finding no beneficial effect of FMT. In total clinical response after FMT was reported in 14 (31.8%) out of 44 evaluated patients at various timepoints after FMT, and clinical remission in ten (22.7%) patients. Only minor self-limiting adverse events were reported. FMT varied greatly regarding preparation, length of treatment, and route of delivery. The effects of FMT on symptoms of chronic pouchitis are not established, though some studies show promising results. Future controlled well-designed studies are warranted.

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“…In a long-term analysis by Lee et al conducted on 23 patients, 12/23 had taken antibiotic therapy for other types of infection during FMT follow-up (urinary tract, dental, appendicitis, pneumonia, sinusitis, cellulitis) and none developed a recurrence of CDI. 18 It should be noted that, in the literature, there is evidence of rare severe adverse events subsequent to FMT that seriously compromised patients health. In some cases, they were preventable with adequate donor screening, such as the recent case of a multi-drug resistant (MDR) infection of two immunocompromised patients following transplantation of a donor’s colonised faeces that were not adequately screened.…”

Section: Discussionmentioning

confidence: 99%

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

Barberio

Facchin

Mele

et al. 2020

Therap Adv Gastroenterol

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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.

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Long-term durability and safety of fecal microbiota transplantation for recurrent or refractory Clostridioides difficile infection with or without antibiotic exposure

Cited by 17 publications

References 22 publications

Autologous fecal microbiota transplantation for the treatment of inflammatory bowel disease

Autologous fecal microbiota transplantation for the treatment of inflammatory bowel disease

Fecal Microbiota Transplantation in the Treatment of Chronic Pouchitis: A Systematic Review

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

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