Single-Donor Fecal Transplant Shows Similar Efficacy Treating C Diff as Multi-Donor

Fecal microbiota transplantation produces cure rates of 82%-88% in patients with recurrent clostridium difficile infections.

Whereas multiple donor fecal microbiota transplantation (FMT) has been found effective in treating recurrent clostridium difficile infections (CDI), use of a single-donor FMT has also shown comparable efficacy, according to a study published online in the Danish Medical Journal.

For the study, the researchers evaluated the clinical efficacy of single-donor FMT to compare cure rates with rates that were previously reported from treatment with multi-donor FMT capsules that were produced at the same stool bank.

In FMT, feces is taken from healthy donors to rebuild the gut microbiota of a patient with CDI. The feces is delivered to the upper or lower endoscopy through enemas or capsules.

Use of FMT has become more prominent, as it has been found an effective treatment for recurrent CDI, with cure rates of 82%-88%, according to the study. FMT has even demonstrated greater efficacy than antibiotics that are commonly used to treat CDI, according to the study.

The researchers noted that FMT is the top treatment for recurrent CDI, as findings indicate that human metabolic profiles could be influenced by the treatment. However, it is not completely understood how multi- or single-donor FMT capsules affect cure rates.

In a retrospective case series, the study authors evaluated 18 patients with recurrent, refractory, or fulminant CDI. Each patient was administered single-donor FMT capsules for 3 days between October and December 2020.

The patients, who were between 22 and 87 years of age, had a median of 2 recurrences of CDI. Clinical cure was defined as the absence of diarrhea or diarrhea with C difficile negative stool samples 8 weeks post treatment.

Each patient with recurrent CDI was pre-treated with oral vancomycin 125 mg and each patient with refractory or fulminant CDI was administered oral vancomycin 500 mg, 4 times per day for 7 to 10 days until 2 days prior to FMT treatment.

A clinical cure occurred in 83.3% (n = 15) of patients with recurrent CDI after 3 days of FMT capsule treatment. Cure rates for single-donor FMT were comparable (P = 1.0) to the previously reported cure rates of 88.9% for multi-donor FMT capsule treatment, according to the study.

Seven patients were hospitalized in the 6 months following treatment, 1 of which was from worsening ulcerative colitis that may have been related to the treatment, according to the study. The other hospital admissions were considered unrelated to the treatment, including 2 deaths that occurred.

“Three days of single-donor FMT capsule treatment was effective and safe in the treatment of recurrent, refractory and fulminant C. difficile infection with cure rates comparable to those of multi-donor FMT capsule treatment,” the authors wrote. “The reported cure rates are in line with those reported in a recently published meta-analysis, including all studies investigating the effects of FMT capsules in recurrent C. difficile infection reporting a primary cure of 85%.”

Reference

Successful treatment of Clostridioides difficile infection with single-donor fecal microbiota transplantation capsules. Denmark Dan Med J 2022;69(2):A09210712. https://ugeskriftet.dk/files/scientific_article_files/2022-01/a09210712_web.pdf. Accessed February 9, 2022.