The use of faeces as a medical treatment for food poisoning and severe diarrhoea dates back to the 4th century, potentially paving the way for modern-day faecal microbiota transplantation (FMT).1 FMT has since been approved as a clinical method for treatment of recurrent C. difficile infections. 2
Based on this success against C. difficile, Dr Karol Lis hypothesised that reintroduction of commensal flora by FMT might also eradicate antibiotic-resistant bacteria from the gut to improve outcomes of allogeneic haematopoietic cell transplantation (alloHCT).3
In this prospective interventional study, three unrelated faecal donors were evaluated according to universal recommendations. The faecal samples were homogenised in saline, filtered, and diluted (100 g faeces/200 mL saline). The day before FMT, proton pump inhibitors, standard bowel cleansing with macrogols and strict diet was applied. The day of the procedure, a nasoduodenal tube infused the faecal sample, which was also repeated the next day.
Complete decolonisation at one month after FMT was the primary endpoint. This was achieved in 15/20 (75%) of participants. The eradication rate of K. pneumoniae was 53%, and 100% with E. coli. Next-generation sequencing of stool samples from donors and patients confirmed that there was a richness of transplanted faecal material in patients after the procedure.
There were no serious adverse events, with 25% experiencing Grade 1, transient diarrhoea within three days after FMT.
Overall, FMT appears to be a valid tool to combat antibiotic-resistant bacteria colonisation of the gut in patients with blood disorders, and for potential modulation of the gut microbiome in the context of alloHCT.