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Superiority of Higher-Volume Fresh Feces Compared to Lower-Volume Frozen Feces in Fecal Microbiota Transplantation for Recurrent Clostridioides Difficile Colitis

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Abstract

Goals

To compare the clinical outcomes of different protocols for fecal microbiota transplantation (FMT) in two community hospitals with similar patient demographics.

Background

FMT is commonly performed for recurrent or refractory Clostridioides difficile infection (rCDI). The clinical efficacy of FMT for this indication has been well established. However, there has been no standardization or optimization of the amount of fecal material, method of feces preparation, or route of delivery for FMT.

Study

In this retrospective study, patients with rCDI received FMT using commercially available frozen fecal preparation (22.7 g) at Center A and locally prepared fresh fecal filtrate (30–50 g) at Center B. The primary outcome was defined as complete resolution of clinical symptoms related to rCDI after at least 8 weeks of follow-up.

Results

Fifty patients from each center were included in the study. Clinical success after initial FMT with lower-volume frozen fecal preparation at Center A was 32/50 (64.0%) compared to 49/50 (98.0%) with higher-volume fresh fecal filtrate at Center B (p < 0.0001). Seventeen patients in Center A and 1 patient in Center B underwent at least one repeat FMT. Overall clinical success was achieved in 43/50 (86%) of patients in Center A and 50/50 (100%) in Center B (p = 0.012).

Conclusions

Our results suggest superior clinical efficacy of a larger amount of fresh fecal filtrate over a smaller amount of commercially available frozen fecal preparation. Further studies are needed to examine the effect of varying amounts of feces and the optimal protocol for FMT in patients with rCDI.

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Authors and Affiliations

  1. Mercy Medical Center, 301 St Paul Pl, Physician’s Office Building, 7th Floor, Baltimore, MD, 21202, USA

    Amol Agarwal, Anurag Maheshwari & Matilda Hagan

  2. Sinai Hospital of Baltimore, Baltimore, MD, USA

    Sandeep Verma, Denise Arrup, Laila Phillips, Rakesh Vinayek, Padmanabhan Nair & Sudhir Dutta

Authors
  1. Amol Agarwal
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  2. Anurag Maheshwari
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  3. Sandeep Verma
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  4. Denise Arrup
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  5. Laila Phillips
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  6. Rakesh Vinayek
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  7. Padmanabhan Nair
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  8. Matilda Hagan
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  9. Sudhir Dutta
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Correspondence to Anurag Maheshwari.

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Agarwal, A., Maheshwari, A., Verma, S. et al. Superiority of Higher-Volume Fresh Feces Compared to Lower-Volume Frozen Feces in Fecal Microbiota Transplantation for Recurrent Clostridioides Difficile Colitis. Dig Dis Sci 66, 2000–2004 (2021). https://doi.org/10.1007/s10620-020-06459-0

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  • DOI: https://doi.org/10.1007/s10620-020-06459-0

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