Faecal microbiota transplantation as a home therapy to frail older people

Simon Mark Dahl Jørgensen, Tone Maria Mørck Rubak, Else Marie Damsgaard, Jens Frederik Dahlerup, Christian Lodberg Hvas, Simon Mark Dahl Jørgensen, Tone Maria Mørck Rubak, Else Marie Damsgaard, Jens Frederik Dahlerup, Christian Lodberg Hvas

Abstract

Background: Clostridioides (Clostridium) difficile infection (CDI) is a leading cause of antibiotics-associated diarrhoea. Faecal microbiota transplantation (FMT) is effective for recurrent CDI and may be provided as a home treatment to frail, older people.

Methods: We present four consecutive patients with recurrent CDI, treated at home using nasojejunal tube-delivered or encapsulated donor faeces. The primary outcome was combined clinical resolution and a negative CD toxin test 8 weeks post-treatment.

Results: All four patients had severe CDI and all improved clinically following one FMT. Sustained resolution following one FMT was observed in one patient. Two patients had recurrence and received a second FMT using capsules; both achieved resolution. One patient who had recurrence declined from further FMT due to fear of relapse and was established on long-term vancomycin. No adverse events related to FMT were observed.

Conclusion: Frail older people may benefit from FMT. Home treatment is a viable option and may be considered both for clinical cure and for palliation.

Keywords: Clostridioides (Clostridium) difficile infection; faecal microbiota transplantation; frailty; older people.

© The Author(s) 2020. Published by Oxford University Press on behalf of the British Geriatrics Society.

References

    1. Bauer MP, Notermans DW, Benthem BH et al. Clostridium difficile infection in Europe: a hospital-based survey. Lancet 2011; 377: 63–73.
    1. Lessa FC, Mu Y, Bamberg WM et al. Burden of Clostridium difficile infection in the United States. N Engl J Med 2015; 372: 825–34.
    1. Surawicz CM, Brandt LJ, Binion DG et al. Guidelines for diagnosis, treatment, and prevention of Clostridium difficile infections. Am J Gastroenterol 2013; 108: 478–98.
    1. Leffler DA, Lamont JT. Clostridium difficile infection. N Engl J Med 2015; 372: 1539–48.
    1. Magill SS, O'Leary E, Janelle SJ et al. Changes in prevalence of health care-associated infections in U.S. hospitals. N Engl J Med 2018; 379: 1732–44.
    1. European Centre for Disease Prevention and Control Healthcare-associated infections: Clostridium difficile infections In: ECDC. Annual Epidemiological Report for 2016. Stockholm: ECDC, 2018.
    1. Girotra M, Garg S, Anand R et al. Fecal microbiota transplantation for recurrent Clostridium difficile infection in the old: long-term outcomes and microbiota changes. Dig Dis Sci 2016; 61: 3007–15.
    1. Henrich TJ, Krakower D, Bitton A et al. Clinical risk factors for severe Clostridium difficile-associated disease. Emerg Infect Dis 2009; 15: 415–22.
    1. Nood E, Vrieze A, Nieuwdorp M et al. Duodenal infusion of donor feces for recurrent Clostridium difficile. N Engl J Med 2013; 368: 407–15.
    1. Hvas CL, Jørgensen SMD, Jørgensen SP et al. Fecal microbiota transplantation is superior to fidaxomicin for treatment of recurrent Clostridium difficile infection. Gastroenterology 2019; 156: 1324–32.
    1. McDonald LC, Gerding DN, Johnson S et al. Clinical practice guidelines for Clostridium difficile infection in adults and children: 2017 update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin Infect Dis 2018; 66: 987–94.
    1. Allegretti JR, Kassam Z, Fischer M et al. Risk factors for gastrointestinal symptoms following successful eradication of Clostridium difficile by fecal microbiota transplantation (FMT). J Clin Gastroenterol 2019; 53: e405–8.
    1. Jørgensen SMD, Hansen MM, Erikstrup C et al. Faecal microbiota transplantation: establishment of a clinical application framework. Eur J Gastroenterol Hepatol 2017; 29: 36–45.
    1. Mullish BH, Quraishi MN, Segal JP et al. The use of faecal microbiota transplant as treatment for recurrent or refractory Clostridium difficile infection and other potential indications: joint British Society of Gastroenterology (BSG) and Healthcare Infection Society (HIS) guidelines. Gut 2018; 67: 1920–41.
    1. Pedersen LH, Gregersen M, Barat I et al. Early geriatric follow-up after discharge reduces mortality among patients living in their own home. A randomised controlled trial. Eur Ger Med 2016; 8: 330–6.
    1. Pilotto A, Ferrucci L, Franceschi M et al. Development and validation of a Multidimensional Prognostic Index for one-year mortality from comprehensive geriatric assessment in hospitalized older patients. Rejuvenation Res 2008; 11: 151–61.
    1. Volpato S, Bazzano S, Fontana A et al. Multidimensional Prognostic Index predicts mortality and length of stay during hospitalization in the older patients: a multicenter prospective study. J Gerontol A Biol Sci Med Sci 2015; 70: 325–31.
    1. Jørgensen SMD, Hvas CL, Dahlerup JF et al. Banking feces: a new frontier for public blood banks? Transfusion 2019; 59: 2776–82.
    1. Jørgensen SMD, Erikstrup C, Dinh KM et al. Recruitment of feces donors among blood donors: results from an observational cohort study. Gut Microbes 2018; 9: 540–50.
    1. Kao D, Roach B, Silva M et al. Effect of oral capsule- vs colonoscopy-delivered fecal microbiota transplantation on recurrent Clostridium difficile infection: a randomized clinical trial. Jama 2017; 318: 1985–93.
    1. Pringle PL, Soto MT, Chung RT et al. Patients with cirrhosis require more fecal microbiota capsules to cure refractory and recurrent Clostridium difficile infections. Clin Gastroenterol Hepatol 2019; 17: 791–3.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe