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Comparing the efficacy of different methods of faecal microbiota transplantation via oral capsule, oesophagogastroduodenoscopy, colonoscopy, or gastric tube

Published:November 18, 2022DOI:https://doi.org/10.1016/j.jhin.2022.11.007

      Summary

      Background

      The increasing prevalence of multidrug-resistant organism (MDRO) carriage poses major challenges to medicine as healthcare costs increase. Recently, faecal microbiota transplantation (FMT) has been discussed as a novel and effective method for decolonising MDRO.

      Aim

      To compare the efficacy of different FMT methods to optimise the success rate of decolonisation in patients with MDRO carriage.

      Methods

      This prospective cohort study enrolled patients with MDRO carriages from 2018 to 2021. Patients underwent FMT via one of the following methods: oral capsule, oesophagogastroduodenoscopy (EGD), colonoscopy, or gastric tube.

      Findings

      A total of 57 patients underwent FMT for MDRO decolonisation. The colonoscopy group required the shortest time for decolonisation, whereas the EGD group required the longest (24.9 vs. 190.4 days, p = 0.022). The decolonisation rate in the oral capsule group was comparable to that in the EGD group (84.6% vs. 85.7%, p = 0.730). An important clinical factor associated with decolonisation failure was antibiotic use after FMT (odds ratio = 6.810, p = 0.008). All four groups showed reduced proportions of MDRO species in microbiome analysis after FMT.

      Conclusion

      Compared to other conventional methods, the oral capsule is an effective FMT method for patients who can tolerate an oral diet. The discontinuation of antibiotics after FMT is a key factor in the success of decolonisation.

      Abbreviations:

      ALT (alanine transaminase), CPE (carbapenemase-producing Enterobacteriaceae), CRE (carbapenem-resistant Enterobacteriaceae), EGD (oesophagogastroduodenoscopy), FMT (faecal microbiota transplantation), IQR (interquartile range), MDRO (multi-drug-resistant organism), VRE (vancomycin-resistant enterococci)
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