Single-Donor FMT Comparable to Multi-Donor FMT for Recurrent C Difficile

Frederick Cold, MD

While multiple donor fecal microbiota transplantation (FMT) has shown efficacy in treating recurrent clostridium difficile infections (CDI), single-donor FMT is also showing comparable efficacy, according to a study that took place in Denmark.

A team, led by Frederik Cold, MD, Department of Gastroenterology, Aleris- Hamlet Hospitals, investigated the clinical efficacy of single-donor FMT and compared cure rates with previously reported cure rates of treatment with multi-donor FMT capsules produced at the same stool bank.

FMT

Fecal microbiota transplantation is a relatively new treatment that involves taking feces from healthy donors to rebuild the gut microbiota of a diseased individual. FMT is delivered through upper or lower endoscopy via enemas or capsules.

In recent years, FMT has emerged as an effective treatment for recurrent C difficile infections, with cure rates of 82-88%. In fact, FMT has shown more efficacy than the antibiotics commonly used to treat the infections.

FMT is considered a top treatment for recurrent CDI with evidence suggesting human metabolic profiles could be influenced by the treatment.

However, it is not entirely understood whether multi-donor or single donor FMT capsules impact cure rates.

Case Series

In the retrospective case series of patients, the investigators examined 18 patients with recurrent, refractory, or fulminant C difficile infections. Each patients was treated for 3 days with single-donor FMTcapsules between October and December 2020 in the capital region of Denmark.

The patients were aged between 22-87 years and had a median of 2 recurrences of C difficile infections.

The investigators defined clinical cure as the absence of diarrhea or diarrhea with C difficile negative stool samples 8 weeks following treatment.

Each patient with recurrent C difficile was pre-treated with oral vancomycin 125 mg and each patient with refractory or fulminant C difficile infection was treated with oral vancomycin 500 mg 4 times day for 7-10 days until 2 days before FMT treatment.

Overall, a clinical cure happened for 83.3% (n = 15) of patients following 3 days of FMT capsule treatments, with cure rates comparable (P = 1.0) to previously reported cure rates of 88.9% for multi-donor FMT capsule treatment of recurrent C difficile infections.

For safety, 7 patients were hospitalized in the 6 months following treatment, 1 of which due to the worsening of ulcerative colitis considered possibly related to the treatment. The other hospital admissions were deemed unrelated to the treatment, including the 2 deaths that occurred.

“Three days of single-donor FMT capsule treatment was effective and safe in the treatment of recurrent, refractory and fulminant C. difficile infection with cure rates comparable to those of multi-donor FMT capsule treatment,” the authors wrote. “The reported cure rates are in line with those reported in a recently published meta-analysis, including all studies investigating the effects of FMT capsules in recurrent C. difficile infection reporting a primary cure of 85%.”

The study, “Successful treatment of Clostridioides difficile infection with single-donor fecal microbiota transplantation capsules,” was published online in the Danish Medical Journal.