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Guidelines
Reorganisation of faecal microbiota transplant services during the COVID-19 pandemic
  1. Gianluca Ianiro1,
  2. Benjamin H Mullish2,
  3. Colleen R Kelly3,
  4. Zain Kassam4,
  5. Ed J Kuijper5,6,
  6. Siew C Ng7,
  7. Tariq H Iqbal8,9,
  8. Jessica R Allegretti10,
  9. Stefano Bibbò1,
  10. Harry Sokol11,12,
  11. Faming Zhang13,
  12. Monika Fischer14,
  13. Samuel Paul Costello15,
  14. Josbert J Keller6,16,
  15. Luca Masucci17,
  16. Joffrey van Prehn6,
  17. Gianluca Quaranta17,
  18. Mohammed Nabil Quraishi8,9,
  19. Jonathan Segal18,
  20. Dina Kao19,
  21. Reetta Satokari20,
  22. Maurizio Sanguinetti17,
  23. Herbert Tilg21,
  24. Antonio Gasbarrini1,
  25. Giovanni Cammarota1
  1. 1 Digestive Disease Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
  2. 2 Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
  3. 3 Division of Gastroenterology, Alpert Medical School of Brown University, Providence, Rhode Island, USA
  4. 4 Finch Therapeutics Group, Somerville, Massachusetts, USA
  5. 5 Center for Microbiota Analysis and Therapy, Department of Medical Microbiology, Leiden University Medical Centre, Leiden, The Netherlands
  6. 6 Netherlands Donor Feces Bank, Leiden University Medical Center, Leiden, The Netherlands
  7. 7 Center for Gut Microbiota Research, Institute of Digestive Disease, Department of Medicine and Therapeutics, State Key Laboratory of Digestive Disease, Li Ka Shing Institute of Health Sciences, Chinese University of Hong Kong, Hong Kong, Hong Kong
  8. 8 Microbiome Treatment Centre, University of Birmingham, Birmingham, UK
  9. 9 Department of Gastroenterology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  10. 10 Gastroenterology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
  11. 11 Service de Gastroenterologie; French Group of Fecal Microbiota Transplantation, Hôpital Saint Antoine, Sorbonne Université, Inserm, Centre de Recherche Saint-Antoine, Paris, France
  12. 12 INRA, UMR1319 Micalis, AgroParisTech, Jouy-en-Josas, France
  13. 13 Medical Center for Digestive Diseases, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
  14. 14 Department of Medicine, Indiana University, Indianapolis, Indiana, USA
  15. 15 Department of Gastroenterology, The Queen Elizabeth Hospital, University of Adelaide, Woodville, South Australia, Australia
  16. 16 Department of Gastroenterology, Haaglanden Medical Center, The Hague, The Netherlands
  17. 17 Institute of Microbiology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
  18. 18 Department of Gastroenterology, St Mark's Hospital, Harrow, UK
  19. 19 Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
  20. 20 Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
  21. 21 Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology & Metabolism, Innsbruck Medical University, Innsbruck, Austria
  1. Correspondence to Professor Giovanni Cammarota, Digestive Diseases Center, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, Rome 00168, Italy; giovanni.cammarota{at}unicatt.it

Abstract

The COVID-19 pandemic has led to an exponential increase in SARS-CoV-2 infections and associated deaths, and represents a significant challenge to healthcare professionals and facilities. Individual countries have taken several prevention and containment actions to control the spread of infection, including measures to guarantee safety of both healthcare professionals and patients who are at increased risk of infection from COVID-19. Faecal microbiota transplantation (FMT) has a well-established role in the treatment of Clostridioides difficile infection. In the time of the pandemic, FMT centres and stool banks are required to adopt a workflow that continues to ensure reliable patient access to FMT while maintaining safety and quality of procedures. In this position paper, based on the best available evidence, worldwide FMT experts provide guidance on issues relating to the impact of COVID-19 on FMT, including patient selection, donor recruitment and selection, stool manufacturing, FMT procedures, patient follow-up and research activities.

  • colonic microflora
  • diarrhoeal disease
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/gutjnl-2020-321829

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    Footnotes

    • Twitter @gianluca1aniro, @jonathansegal1985, @GiovanniCammar9

    • Contributors GC conceived the idea of the project. GC and GI organised and designed the project, selected the expert panel and established the main topics. GC, GI, CRK, BHM and ZK wrote the initial draft of the manuscript. All panel members read and revised the manuscript for important intellectual content and approved the final manuscript.

    • Funding The project was in part funded by the Catholic University of Rome, Line D-1 research funding.

    • Competing interests AG reports personal fees for consultancy from Eisai Srl, 3PSolutions, Real Time Meeting, Fondazione Istituto Danone, Sinergie Srl, Board MRGE and Sanofi SpA personal fees for acting as a speaker for Takeda SpA, AbbVie and Sandoz SpA and personal fees for acting on advisory boards for VSL3 and Eisai. BHM reports personal fees from Finch Therapeutics Group. CRK has served as a clinical advisor, with no financial compensation, for OpenBiome since 2013; she is a local principal investigator for the PRISM-3 clinical trial, for which her institution receives some salary support for a research coordinator and compensation from Finch Therapeutics Group for each patient enrolled. FZ reports grants from the non-profit China Microbiota Transplantation System (fmtBank) and has a patent for GenFMTer for separating microbiota issued to FMT medical. GC has received personal fees for acting as advisor for Ferring Therapeutics. GI has received personal fees for acting as speaker from Biocodex, Danone, Metagenics, and for acting as consultant/advisor from Ferring Therapeutics, Giuliani, Metagenics. HS reports personal fees from Danone, Enterome, Takeda, AbbVie, Roche, Amgen, Danone, BiomX, Ferring, BMS, Astellas, MSD, Novartis, Tillotts Pharma, and Biose, and grants from Biocodex, Danone and BiomX, and is a co-founder of Exeliom Biosciences. JJK and EJK report grants from Vedanta Biosciences. JRA reports personal fees from Finch Therapeutics and has a non-financial relationship with OpenBiome as a scientific advisor. MF reports personal fees from Finch Therapeutics Group, Rebiotix, Takeda, AbbVie and Janssen. SCN reports grants from Ferring and personal fees from Takeda, AbbVie, Janssen and Tillotts. SPC reports non-financial support from Janssen and personal fees from Shire, Ferring, Microbiotica and Pfizer. ZK is an employee and shareholder of Finch Therapeutics and is an unpaid special advisor for OpenBiome.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement There are no data in this work.