Fecal Microbiome Transplantation for Recurrent CDI: Treatment Efficacy and Safety with Oral Capsules

Tadas Urbonas; Dalius Petrauskas; Vytautas Kiudelis; Laimas Jonaitis; Jurgita Skieceviciene; Rolandas Gedgaudas; Edita Kiudeliene; Irena Valantiene; Romanas Zykus; Greta Varkalaite; Ruta Inciuraite; Elzbieta Trapenske; Ugne Kulokiene; Paulius Jonaitis; Rima Ramonaite; Justina Velickiene; Aida Zvirbliene; Egidijus Morkunas; Irma Kuliaviene; Jolanta Sumskiene; Kestutis Adamonis; Andrius Macas; Kristina Kupcinskiene; Laura Lukosiene; Dainius Janciauskas; Lina Poskiene; Astra Vitkauskiene; Gianluca Ianiro; Antonio Gasbarrini; Gediminas Kiudelis; Juozas Kupcinskas

doi:10.15403/jgld-5990

Authors

Tadas Urbonas Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas; Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
Dalius Petrauskas Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas, Lithuania
Vytautas Kiudelis Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas; Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
Laimas Jonaitis Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas; Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
Jurgita Skieceviciene Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
Rolandas Gedgaudas Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas; Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
Edita Kiudeliene Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas; Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
Irena Valantiene Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas, Lithuania
Romanas Zykus Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas, Lithuania
Greta Varkalaite Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
Ruta Inciuraite Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
Elzbieta Trapenske Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
Ugne Kulokiene Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
Paulius Jonaitis Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas; Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
Rima Ramonaite Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
Justina Velickiene Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
Aida Zvirbliene Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas, Lithuania
Egidijus Morkunas Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas; Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
Irma Kuliaviene Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas, Lithuania
Jolanta Sumskiene Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas, Lithuania
Kestutis Adamonis Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas, Lithuania
Andrius Macas Department of Anesthesiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
Kristina Kupcinskiene Department of Anesthesiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
Laura Lukosiene Department of Anesthesiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
Dainius Janciauskas Department of Patology, Lithuanian University of Health Sciences, Kaunas, Lithuania
Lina Poskiene Department of Patology, Lithuanian University of Health Sciences, Kaunas, Lithuania
Astra Vitkauskiene Department of Laboratory Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
Gianluca Ianiro Digestive Disease Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Del Sacro Cuore, Rome, Italy
Antonio Gasbarrini Digestive Disease Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Del Sacro Cuore, Rome, Italy
Gediminas Kiudelis Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas; Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
Juozas Kupcinskas Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas; Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania

DOI:

https://doi.org/10.15403/jgld-5990

Keywords:

Fecal microbiota transplantation, FMT, C. difficile colitis, microbiome

Abstract

Background and Aims: Fecal microbiota transplantation is an effective treatment method for recurrent Clostridioides difficile infection. Widely used enteric tube and colonoscopy methods demonstrate excellent efficacy and safety results. Recent data suggest that new fecal microbiota transplantation methods using oral capsules may provide a less invasive approach. In this study, we aimed to compare primary fecal microbiota transplantation efficacy as well as short- and long-term safety of two different administration routes: oral capsules and enteric tube.

Methods: This retrospective study included 60 consecutive patients who underwent fecal microbiota transplantation for recurrent Clostridioides difficile infection. Thirty participants received 50 oral capsules containing frozen material for a single day and 30 patients received fecal microbiota transplantation via nasoenteric tube. All patients received standard treatment with oral vancomycin 500 mg q.i.d. for at least five days before the procedure. After intervention, patients were followed up for at least six months. Data on Clostridioides difficile infection recurrences and health status were collected and analyzed.

Results: The oral capsules group consisted of 30 patients. Among them, 22 (73.3%) participants experienced resolution of symptoms after a single fecal microbiota transplantation, while eight (26.7%) patients developed recurrent diarrhea within eight weeks. The other 30 patients received treatment via nasoenteric tube. Among them, 24 (80%) patients were cured after a single fecal microbiota transplantation, while six (20%) experienced recurrent disease within eight weeks. The primary efficacy did not show significant differences between the two groups (p=0.85). Throughout the follow-up period, no serious adverse events or fecal microbiota transplantation related deaths were reported in both groups.

Conclusions: Fecal microbiota transplantation with frozen oral capsules is a safe, less invasive method with comparable efficacy to nasoenteric administration route.