21 Nov Fecal Microbiota Transfer Effective in Over 80% of Recurrent C. Diff Infection

MedicalResearch.com Interview with:
Yvette van Beurden
PhD student Gastroenterology & Hepatology / Medical Microbiology & Infection Control
VU University medical center
Amsterdam, the Netherlands

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The use of fecal microbiota transfer (FMT), which is defined as the transfer of intestinal microbiota from healthy donors to patients, has gained momentum across the globe, since it was established as a highly effective method for treatment of recurrent Clostridium difficile infection (CDI), with cure rates around 85%. However, worldwide implementation of FMT is currently limited by a lack of uniform guidelines, concerns about safety, and remaining uncertainty of long-term side effects.

In our study, we reported the long-term follow up of patients treated with FMT for recurrent CDI.
With a primary cure rate of 82%, our study supports the currently available evidence that fecal microbiota transfer is a very effective treatment for recurrent CDI. Importantly, a first post-FMT recurrence of CDI can be successfully treated with antibiotics.

Although fecal microbiota transfer is a very effective and, in general, safe treatment for recurrent CDI, we should be aware that complications do occur. In our cohort 13% experienced regurgitation or vomiting after  fecal microbiota transfer via a nasoduodenal tube. Therefore, in every patient the ideal delivery route of donor feces (via duodenal tube, colonoscopy or enema) should be assessed.

MedicalResearch.com: What should readers take away from your report?
-fecal microbiota transfer is a very effective treatment for recurrent  Clostridium difficile infection
– A post-FMT recurrence can be successfully treated with CDI antibiotics, with a theoretically preference for fidaxomicin.
– In every patient the ideal delivery route of donorfeces should be assessed; patients with increased aspiration risk or with a swallowing disorder should be excluded from FMT via nasoduodenal tube
– In our cohort, with a follow-up period of more than five years in some patients, no long-term side effects (e.g. infectious complications, auto-immune disease, obesity, diabetes) were reported.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: A randomized controlled trial comparing duodenal versus colonic delivery of donor feces is required to determine the optimal route for FMT delivery.

In addition, a study comparing upper-FMT with and without bowel lavage would be welcome.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Yvette H van Beurden, Pieter F de Groot, Els van Nood, Max Nieuwdorp, Josbert J Keller, and Abraham Goorhuis
Complications, effectiveness, and long term follow-up of fecal microbiota transfer by nasoduodenal tube for treatment of recurrent Clostridium difficile infection United European Gastroenterology Journal 2050640616678099, first published on November 2, 2016doi:10.1177/2050640616678099

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Last Updated on November 21, 2016 by Marie Benz MD FAAD