Faecal Microbiota Transplantation for Recurrent Clostridioides difficile Infection: Experience with Lyophilized Oral Capsules

Abstract Background Faecal microbiota transplantation (FMT) is a highly effective approach for refractory and recurrent Clostridioides difficile infection (CDI). Despite its excellent efficacy, FMT is not yet a routine procedure in most centres. There is very little experience with FMT based on lyophilized capsules, and data from European institutions are lacking. Here, we describe our experience with FMT to treat recurrent CDI using lyophilized oral capsules. Methods We analyzed a prospectively recorded single-center case series of patients with recurrent CDI who underwent FMT between January 2018 and May 2019. The primary outcome was defined as resolution of CDI without recurrences over a 2-month period. Overall resolution was defined as resolution of diarrhea without recurrence of CDI within 2 months after a further cycle of FMT. The FMT process involved oral ingestion of 4-5 lyophilized capsules in a single dose. All stool donors were rigorously screened. Results FMT was performed in 32 patients. There were no procedure-related adverse events, and no complications were observed. Primary cure was achieved in 81.3% of patients, and the overall cure rate was 87.5%. FMT via lyophilized capsules was well tolerated. No FMT procedure–related adverse events and no further complications were observed for lyophilized capsule FMT. Conclusions Our initial clinical experience suggests that FMT based on oral lyophilized preparations is a safe, well-tolerated, and highly effective treatment for recurrent CDI. Administration of oral lyophilized capsules seems feasible in hospital routine and will enable FMT to be more widely used.