An oral capsule delivery method for fecal microbiota transplantation (FMT) is well tolerated and may be more effective than other delivery methods, according to study results presented at IDWeek 2022, held from October 19 to 23, 2022, in Washington, DC.
Researchers conducted a prospective cohort study to evaluate the safety and efficacy of 4 FMT delivery methods. Between 2018 and 2021, patients with multidrug-resistant (MDR) organism carriage underwent either colonoscopy (n=23), oral capsule (n=14), gastric tube (n=11), or esophagogastroduodenoscopy (EGD; n=9) for FMT delivery, which was based on medical history and oral diet eligibility. Decolonization and recolonization of MDR Organisms were evaluated from stool cultures collected through 1 year.
The study population comprised 59.6% men, the median age was 65.0 (IQR, 52.5-75.0) years, and the mean BMI was 21.1±3.7 kg/m2. Within this patient population, 42.1% carried vancomycin-resistant Enterococci, 21.1% carried carbapenemase-producing Enterobacteriaceae, and 36.8% carried both Enterococci and Enterobacteriaceae. Stratified by delivery method, significant group differences were observed for alanine transaminase levels (P =.005) and carriage of Enterococci (P =.010) and mixed (P =.010) MDR organisms.
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The mean time to decolonization was shortest for patients in the colonoscopy group (24.9 days), followed by those in the gastric tube (90.8 days), oral capsule (75.8 days), and EGD (190.4 days; P =.005) groups.
The rate of decolonization was highest for patients in the EGD group (85.7%), followed by those in the oral capsule (84.6%), colonoscopy (63.6%), and gastric tube (50%) groups. Recolonization occurrence was most unlikely with the EGD (11.1%) delivery method, followed by the colonoscopy (17.5%), gastric tube (18.2%), and oral capsule (28.6%) methods.
Decolonization following FMT was associated with antibiotic use 1 week after FMT (odds ratio [OR], 6.810; 95% CI, 1.641-28.257; P =.008).
In the microbiome analysis, the alpha index improved following FMT for the oral capsule and EGD recipients.
This study was limited by its small sample size and imbalances between the patient groups.
According to the researchers, “The oral capsule is an effective FMT method for patients who are tolerable to an oral diet compared to the other conventional methods.” They concluded that the “Discontinuation of antibiotics after FMT is critical in decolonization.”
Reference
Lee EH, Lee KH, Kim J, et al. Comparing different delivery methods of fecal microbiota transplantation. Presented at: IDWeek 2022; October 19-23, 2022; Washington, DC. Poster 515.
This article originally appeared on Infectious Disease Advisor
