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

Elisabeth M Terveer,Karuna Ew Vendrik,Rogier E Ooijevaar,Marcel Gw Dijkgraaf,Christina Mje Vandenbroucke‐Grauls,Els Van Nood,Joffrey Van Prehn,Martijn P Bauer,Eline Boeije‐Koppenol,Chris Jj Mulder,Jos Fml Seegers,Ed J Kuijper,Abraham Goorhuis,Yvette H Van Beurden,Hein W Verspaget,Josbert J Keller,Emilie Van Lingen

doi:10.1177/2050640620957765

Abstract

BackgroundThe Netherlands Donor Feces Bank provides standardized ready-to-use donor faecal suspensions for faecal microbiota transplantation treatment of patients with recurrent Clostridioides difficile infection.ObjectiveThe purpose of this study was evaluation of safety, feasibility and outcome of faecal microbiota transplantation facilitated by a national stool bank.MethodsThe 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.ResultsOf 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.ConclusionFaecal 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 evidenceLevel II, prospective cohort study

Highlights

Faecal microbiota transplantation (FMT) is a very effective treatment for recurrent Clostridioides difficile infection
With the emergence of FMT as a new treatment approach, stool banks are needed to provide ready-to-use donor faecal suspensions that are produced in a standardized way.[7]
Significant advantages of centralized donor screening and production of donor faecal suspensions are the possibilities of providing quality assurance, and appropriate monitoring of potential yet unknown adverse events.[7]

Summary

Introduction

Faecal microbiota transplantation (FMT) is a very effective treatment for recurrent Clostridioides difficile infection (rCDI). In recent years it has been implemented worldwide as an effective rescue therapy with cure rates of approximately 85%.1–4. 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. 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.

Objectives

Methods

Results