Clinical effectiveness of bidirectional fecal microbiota transfer in the treatment of recurrent Clostridioides difficile infections
Christian Bestfater, Maria J G T Vehreschild, Andreas Stallmach, Kester Tüffers, Andreas Erhardt, Thorsten Frank, Thomas Glück, Felix Goeser, Gernot Sellge, Philipp Solbach, Herbert Eisenlohr, Martin Storr, German Clinical Microbiome Study Group (GCMSG), Christian Bestfater, Maria J G T Vehreschild, Andreas Stallmach, Kester Tüffers, Andreas Erhardt, Thorsten Frank, Thomas Glück, Felix Goeser, Gernot Sellge, Philipp Solbach, Herbert Eisenlohr, Martin Storr, German Clinical Microbiome Study Group (GCMSG)
Abstract
Background: Fecal microbiota transfer (FMT) has become a standard of care in the prevention of multiple recurrent Clostridioides difficile (rCDI) infection.
Aim: While primary cure rates range from 70-80% following a single treatment using monodirectional approaches, cure rates of combination treatment remain largely unknown.
Methods: In a retrospective case-control study, outcomes following simultaneous bidirectional FMT (bFMT) with combined endoscopic application into the upper and lower gastrointestinal tract, compared to standard routes of application (endoscopy via upper or lower gastrointestinal tract and oral capsules; abbreviated UGIT, LGIT and CAP) on day 30 and 90 after FMT were assessed. Statistical matching partners were identified using number of recurrences (<3; ≥3), age and gender.
Results: Primary cure rates at D30 and D90 for bFMT were 100% (p=.001). The matched control groups showed cure rates of 81.3% for LGIT (p=.010), 62.5% for UGIT (p=.000) and 78.1% for CAP (p=.005) on D30 and 81.3% for LGIT (p=.010), 59.4% for UGIT (p=.000) and 71.9% for CAP (p=.001) on D90.
Conclusion: In our analysis, bFMT on the same day significantly increased primary cure rate at D30 and D90. These data require prospective confirmation but suggest that route of application may play a significant role in optimizing patient outcomes. ClinicalTrials.gov no: NCT02681068.
Keywords: Bidirectional FMT (bFMT); Clostridioides difficile infection (CDI); Fecal microbiota transfer (FMT); Stool transplant.
Conflict of interest statement
Declaration of Competing Interest Maria J.G.T. Vehreschild has served at the speakers bureau of Akademie für Infektionsmedizin, Ärztekammer Nordrhein, Astellas Pharma, Basilea, Gilead Sciences, Merck/MSD, Organobalance, and Pfizer, received research funding from 3 M, Evonik, Glycom, Astellas Pharma, DaVolterra, Gilead Sciences, MaaT Pharma, Merck/MSD, Morphochem, Organobalance, and Seres Therapeutics and is a consultant to Alb-Fils Kliniken GmbH, Arderypharm, Astellas Pharma, Ferring, DaVolterra, MaaT Pharma, and Merck/MSD. Andreas Stallmach served as a speaker, a consultant and/or an advisory board member for Astellas Pharma, Ferring Arzneimittel GmbH, Institute AllergoSan, MSD and Summit Therapeutics. Martin Storr served as a speaker, a consultant and/or an advisory board member for Astellas Pharma and MSD. The remaining authors declare no conflict of interest.
Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.
Source: PubMed