Frozen fecal transplantation as good as fresh for C. difficile infections

By John Murphy, MDLinx
Published January 15, 2016

Key Takeaways

Material for fecal microbiota transplantation (FMT) that has been frozen and thawed is as effective as fresh material for treating diarrhea in patients with recurrent or non-responsive Clostridium difficile infection, according to a study in the January 12, 2016 issue of JAMA.   

This finding indicates that frozen FMT is a reasonable treatment option for these patients, the researchers concluded.

C. difficile infects nearly half a million Americans and causes at least 29,000 deaths per year, the Centers for Disease Control and Prevention estimates. But treatment options for recurrent C. difficile infection are limited. So, restoring the normal gut flora by means of fecal microbiota transplantation is a promising, but not readily available, treatment for recurrent infection.

It's not readily available because the “shelf life” of fresh material is only about 24 hours. However, frozen material can last as long as a year, researchers noted.

This is but one of the many potential advantages of providing frozen FMT, said lead author of the study Christine Lee, MD, Professor of Pathology and Molecular Medicine at McMaster University’s Michael G. DeGroote School of Medicine, in Hamilton, Ontario, Canada. “There would be less cost for donor screening, and it could be made more conveniently available, even for centers that do not have on-site labs,” she explained.

In this trial, Dr. Lee and colleagues randomly assigned 232 adult patients with recurrent or refractory C. difficile infection to receive either frozen or fresh FMT by enema. By 13 weeks after treatment, 83.5% of patients treated with frozen FMT and 85% treated with fresh FMT had clinical resolution of diarrhea without relapse. There were no differences between the treatment groups in the amount of adverse or serious adverse events.

“The results presented by Lee et al offer the best evidence to date supporting the use of frozen stool … for FMT and will likely expand the availability of FMT for patients with recurrent CDI,” wrote Preeti N. Malani, MD, MSJ, and Krishna Rao, MD, MS, of the University of Michigan Health System, Ann Arbor, MI, in an accompanying editorial.

“The ability to use frozen stool eliminates many of the logistical burdens inherent to FMT, because stool collection and processing need not be tied to the procedure date and time,” they wrote. “This study also provides greater support for the practice of using centralized stool banks, which could further remove barriers to FMT by making available to clinicians safe, screened stool that can be shipped and stored frozen and thawed for use as needed. In theory, procedure costs may also be decreased, since comprehensive donor screening is expensive.”

Next, Dr. Lee’s team will be testing freeze-dried material which, if it proves as effective as fresh or frozen FMT, would further expand the availability and convenience of this treatment.

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