Fecal microbiome transplantation via enema, jejunal catheter, or by colonscopy are usual methods for arresting rCDI. After 73 procedures over 10 years (70/73 respondants), an oral capsule procedure was developed in July 2010 to account for patients who could not tolerate a jejunal catheter (esophageal varices) and/or were unable to retain fecal enemas due to anal incontinence and failed arrest of rCDI.
Patients with >3 rCDI episodes were referred for FMT. rCDI was controlled with oral vancomycin. On the day of the procedure, related donors, previously screened for transmissible pathogens, provided ~100 grams of freshly passed feces. The fecal sample was suspended in 600-800 ml of prereduced PBS. Over 2.6 h, serial centrifugation at 400xg, 1000xg and 6000xg with interspersed decanting of the supernatant layer recovered pelleted fecal microbes in the sediment of the last centrifugation step. The sediment was resuspended in a minimal amount of PBS to allow micropipetting into #1 gelatin capsules (0.47 ml), and overcapsulated further with #0 and #00 capsules. The recipient stopped vancomycin on the day prior to the procedure and at 05:00 h on the procedure day underwent a colonic cleansing with picosalix. At 13:00 h, without antacid premedication, the recipient ingested freshly assembled capsules (n=24-34) over 5-15 minutes on an empty stomach. Prior testing of capsules showed that capsules remained intact for over 2 h at RT and ~1 h at 35o C in stirred liquid. qPCR testing of the sediment of donor and serial recipient fecal samples, prior to and a week, 1, 3 and 6 months post FMT, was performed.
To date, 27/27 recipients have arrested rCDI with one oral procedure. No patients vomited after ingestion of the capsules and the procedure was well tolerated. qPCR analysis of the donor stool sample and final capsule sediment showed similar microbial content and quantity. After FMT numbers of Bacteroides, C.coccoides, C. leptum, Prevotella, Bifidobacteria and Desulfovibrio were significantly increased and Enterobacteriaceae and Veillonella were significantly decreased.
FMT, via ingestion of fecal microbes contained in double over-encapsuled gelatin capsules, appears to be a convenient and effective approach to arrest the cycle of rCDI.
H. O'grady, None
K. Wu, None
L. Ward, None
See more of: Oral Abstract Session