Stool Banking During the COVID-19 Pandemic: Experiences and a Retrospective Comparative Cohort Study

Abstract

Background: Faecal microbiota transplantation (FMT) is an efficacious treatment for recurrent Clostridioides difficile infections (rCDI), and seems promising for other microbiota related disorders. Stool banks ensure safe and effective application of FMT by providing screened faecal suspensions from healthy donors. Due to the ongoing coronavirus disease 2019 (COVID-19) pandemic and the potential risk of SARS coronavirus-2 (SARS-CoV-2) transmission via FMT, many stool banks were forced to halt donor activities. Here we describe a strategy to effectively restart stool banking activities during the COVID-19 pandemic. \n \nMethods: We implemented periodic SARS-CoV-2 screening in donor faeces and serum, and frequent donor assessment for COVID-19 related symptoms. In this retrospective comparative cohort study, FMT donor and recipient data obtained before (2016-2019) and during the COVID-19 pandemic (March 2020-March 2021) was compared to assess stool banking efficacy. \n \nFindings: One active donor developed COVID-19 (10%, 1/10). Of 31 FMT-treated patients, one developed COVID-19 three weeks after FMT. No differences during versus before the COVID-19 pandemic were observed in the number of faecal donations (16 vs 22/month [-13·24-2·26], p=0·1); FMT requests for rCDI (3·8 vs 4·5/month [-2·22-0·83], p=0·3); rCDI patients eligible for FMT (73·8% vs 73·3%, OR=1·03 [0·48-2·21], p=0·9); rCDI cure rate (95·2% vs 89·1%, OR=0·41 [0·05-3·32], p=0·5); CDI free survival (p=0·1); the number of non-rCDI patients treated with FMT (five vs five), and the number of possibly FMT related adverse events (AEs) (12·0% vs 7·8%, OR=1·61 [0·40-6·42], p=0·7). Two FMTs for rCDI were delayed due to COVID-19. Clinical trials were hampered, however two out of three resumed all activities. \n \nInterpretation: There is a continued need for FMT treatment of rCDI. By implementing appropriate donor screening and SARS-CoV-2 infection prevention measures, safe, effective and efficient stool banking to facilitate FMT during the COVID-19 pandemic is possible. \n \nFunding Information: The Netherlands Donor Feces Bank has received an unrestricted grant of Vedanta Biosciences. \n \nDeclaration of Interests: We declare no competing interests. \n \nEthics Approval Statement: This study conforms to the ethical guidelines of the 1975 Declaration of Helsinki as reflected in a priori approval by the institution’s Human Research Committee, and was approved on December 16th 2015 by the METC of the LUMC (P15.154). Written informed consent was provided by donors and patients for collection and analysis of clinical data and faeces samples.