Abstract
BackgroundFecal microbiota transplantation is an effective treatment for recurrent Clostridium difficile infection and is being investigated as a treatment for other microbiota-associated diseases. To facilitate these activities, an international public stool bank has been created, which screens donors and processes stools in a standardized manner. The goal of this research is to use mathematical modeling and analysis to optimize screening and donor management at the stool bank.ResultsCompared to the current policy of screening active donors every 60 days before releasing their quarantined stools for sale, costs can be reduced by 10.3 % by increasing the screening frequency to every 36 days. In addition, the stool production rate varies widely across donors, and using donor-specific screening, where higher producers are screened more frequently, also reduces costs, as does introducing an interim (i.e., between consecutive regular tests) stool test for just rotavirus and C. difficile. We also derive a donor release (i.e., into the system) policy that allows the supply to approximately match an exponentially increasing deterministic demand.ConclusionsMore frequent screening, interim screening for rotavirus and C. difficile, and donor-specific screening, where higher stool producers are screened more frequently, are all cost-reducing measures. If screening costs decrease in the future (e.g., as a result of bringing screening in house), a bottleneck for implementing some of these recommendations may be the reluctance of donors to undergo serum screening more frequently than monthly.Electronic supplementary materialThe online version of this article (doi:10.1186/s40168-015-0140-3) contains supplementary material, which is available to authorized users.
Highlights
Fecal microbiota transplantation is an effective treatment for recurrent Clostridium difficile infection and is being investigated as a treatment for other microbiota-associated diseases
Frontline treatment with metronidazole or vancomycin have suffered from increasing failure rates in recent years [4], fecal microbiota transplantation (FMT), i.e., stool transplanted from a healthy donor that reconstitutes the normal microbiota community in the gut, has emerged as an effective treatment, with a cure rate of 90 % in recurrent cases [5]
To assess the improvements from optimal screening relative to the status quo, and to identify the importance of interim testing and the importance of allowing testing frequency to depend on donor-specific stool production rates, we consider the five policies in Table 2, which include the status quo policy used by OpenBiome (D = 60 days and no interim testing [9]) and the optimal policy to the optimization problem described above
Summary
Fecal microbiota transplantation is an effective treatment for recurrent Clostridium difficile infection and is being investigated as a treatment for other microbiota-associated diseases. To facilitate these activities, an international public stool bank has been created, which screens donors and processes stools in a standardized manner. We use OpenBiome data to build a mathematical model that tracks the process flow of stools from donation to sale This model is embedded into an optimization problem that releases new donors and chooses the donorspecific frequency of stool and blood screening to minimize donating, processing and screening costs subject to meeting an exponentially increasing demand
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