How to Apply FMT More Effectively, Conveniently and Flexible - A Comparison of FMT Methods

Adorján Varga, Béla Kocsis, Dávid Sipos, Péter Kása, Szabolcs Vigvári, Szilárd Pál, Fanni Dembrovszky, Kornélia Farkas, Zoltán Péterfi, Adorján Varga, Béla Kocsis, Dávid Sipos, Péter Kása, Szabolcs Vigvári, Szilárd Pál, Fanni Dembrovszky, Kornélia Farkas, Zoltán Péterfi

Abstract

Purpose: Metronidazol and vancomycin were long the two best options against Clostridioides (formerly Clostridium) difficile infections (CDI). Now, the cost of new drugs such as fidaxomicin directs us towards alternative treatment options, such as faecal microbiota transplant (FMT). Its effectiveness is similar to fidaxomicin. There are questions regarding its safety, but the biggest challenges are prejudice and inconvenience. Most protocols refer to FMT applied in the form of a solution. We investigated different modalities of FMT.

Methods: Instead of using nasoenteric tubes or colonoscopy, we place frozen or lyophilised stool in non-coated, size "00", hard gelatine capsules or enterosolvent, size "0" capsules.

Results: We found that non-coated, size "00", hard gelatine capsules are appropriate for conducting FMT. Capsules containing lyophilised supernatant with a low number of bacteria have been proven to be non-inferior to other FMT modalities. The primary cure rate in the supernatant group was 93.75%, and 66.67% in the sediment group. The overall cure rate was 82.14%. Depending on the protocol, 4-7 capsules are sufficient per patient. Capsules can be stored for up to one year at -20°C.

Conclusions: FMT is a feasible alternative to antibiotic treatments in CDI. Our method makes the process flexible and less inconvenient to patients. Long storage time allows a consistent supply of capsules, while small volume and formulation make the procedure tolerable.

Keywords: Clostridioides difficile infection; capsules; faecal microbiota transplant; faecal sediment; faecal supernatant; lyophilisation; recurrence.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2021 Varga, Kocsis, Sipos, Kása, Vigvári, Pál, Dembrovszky, Farkas and Péterfi.

Figures

Figure 1
Figure 1
Flowchart of our study.
Figure 2
Figure 2
Options to administer the faecal solution. Lyophilised samples can be resuspended and administered via a nasoenteric tube or colonoscopy (not shown in the figure).
Figure 3
Figure 3
Mean CFU counts on a logarithmic scale in anaerobe and aerobe cultures from supernatant and sediment samples. CFU, Colony-Forming Units.
Figure 4
Figure 4
Survival of bacteria depending on the temperature of storage. CFU, Colony-Forming Units.

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