Lyophilised fecal microbiota transfer in capsules for recurrent Clostridioides difficile infection.

Background: Recent guidelines recommend fecal microbiota transplantation (FMT) for patients who experience multiple episodes of Clostridioides difficile infection (CDI). The availability of lyophilised and encapsulated FMT in recent years has greatly improved patient comfort and convenience. While the effectiveness of FMT in oral capsules seems comparable to that achieved through other routes, further experience is needed, particularly in Europe, where there is currently limited published experience. The objective of this study was to present our experience with this therapeutic modality.

Methods: A retrospective cohort study on patients with recurrent CDI treated by lyophilised, encapsulated FMT. All patients were followed for a minimum of 12 weeks. The primary outcome was recurrence at three months.

Results: A total of 36 patients received 38 FMTs. The median age of the cohort was 78.5 years, with a median of four previous episodes. At the three-month follow-up, 27 of the 36 patients (75.0%) were free of CDI. One patient exhibited recurrence before the six-month mark. Two of the ten patients with FMT failure were successfully rescued with a second FMT. Of the nine patients who underwent rescue attempts, seven did not experience recurrence, resulting in a cure rate of 91.7% for the 36 patients. We did not detect severe adverse effects related to the FMT.

Conclusion: We confirm an acceptable effectiveness of lyophilised capsulated oral FMT. Interestingly, most patients with FMT failure can be cured with a new treatment, which need not necessarily be a new FMT.