Practice Guideline

. 2020 Sep;69(9):1555-1563.

doi: 10.1136/gutjnl-2020-321829. Epub 2020 Jul 3.

Reorganisation of faecal microbiota transplant services during the COVID-19 pandemic

Gianluca Ianiro¹, Benjamin H Mullish², Colleen R Kelly³, Zain Kassam⁴, Ed J Kuijper^{5

6}, Siew C Ng⁷, Tariq H Iqbal^{8

9}, Jessica R Allegretti¹⁰, Stefano Bibbò¹, Harry Sokol^{11

12}, Faming Zhang¹³, Monika Fischer¹⁴, Samuel Paul Costello¹⁵, Josbert J Keller^{6

16}, Luca Masucci¹⁷, Joffrey van Prehn⁶, Gianluca Quaranta¹⁷, Mohammed Nabil Quraishi^{8

9}, Jonathan Segal¹⁸, Dina Kao¹⁹, Reetta Satokari²⁰, Maurizio Sanguinetti¹⁷, Herbert Tilg²¹, Antonio Gasbarrini¹, Giovanni Cammarota²²

Affiliations

¹ Digestive Disease Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
² Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK.
³ Division of Gastroenterology, Alpert Medical School of Brown University, Providence, Rhode Island, USA.
⁴ Finch Therapeutics Group, Somerville, Massachusetts, USA.
⁵ Center for Microbiota Analysis and Therapy, Department of Medical Microbiology, Leiden University Medical Centre, Leiden, The Netherlands.
⁶ Netherlands Donor Feces Bank, Leiden University Medical Center, Leiden, The Netherlands.
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 Microbiome Treatment Centre, University of Birmingham, Birmingham, UK.
⁹ Department of Gastroenterology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
¹⁰ Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
¹¹ Service de Gastroenterologie; French Group of Fecal Microbiota Transplantation, Hôpital Saint Antoine, Sorbonne Université, Inserm, Centre de Recherche Saint-Antoine, Paris, France.
¹² INRA, UMR1319 Micalis, AgroParisTech, Jouy-en-Josas, France.
¹³ Medical Center for Digestive Diseases, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, China.
¹⁴ Department of Medicine, Indiana University, Indianapolis, Indiana, USA.
¹⁵ Department of Gastroenterology, The Queen Elizabeth Hospital, University of Adelaide, Woodville, South Australia, Australia.
¹⁶ Department of Gastroenterology, Haaglanden Medical Center, The Hague, The Netherlands.
¹⁷ Institute of Microbiology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy.
¹⁸ Department of Gastroenterology, St Mark's Hospital, Harrow, UK.
¹⁹ Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
²⁰ Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
²¹ Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology & Metabolism, Innsbruck Medical University, Innsbruck, Austria.
²² Digestive Disease Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy giovanni.cammarota@unicatt.it.

PMID: 32620549
PMCID: PMC7456726
DOI: 10.1136/gutjnl-2020-321829

Practice Guideline

Reorganisation of faecal microbiota transplant services during the COVID-19 pandemic

Gianluca Ianiro et al. Gut. 2020 Sep.

. 2020 Sep;69(9):1555-1563.

doi: 10.1136/gutjnl-2020-321829. Epub 2020 Jul 3.

Authors

Affiliations

¹ Digestive Disease Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
² Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK.
³ Division of Gastroenterology, Alpert Medical School of Brown University, Providence, Rhode Island, USA.
⁴ Finch Therapeutics Group, Somerville, Massachusetts, USA.
⁵ Center for Microbiota Analysis and Therapy, Department of Medical Microbiology, Leiden University Medical Centre, Leiden, The Netherlands.
⁶ Netherlands Donor Feces Bank, Leiden University Medical Center, Leiden, The Netherlands.
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 Microbiome Treatment Centre, University of Birmingham, Birmingham, UK.
⁹ Department of Gastroenterology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
¹⁰ Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
¹¹ Service de Gastroenterologie; French Group of Fecal Microbiota Transplantation, Hôpital Saint Antoine, Sorbonne Université, Inserm, Centre de Recherche Saint-Antoine, Paris, France.
¹² INRA, UMR1319 Micalis, AgroParisTech, Jouy-en-Josas, France.
¹³ Medical Center for Digestive Diseases, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, China.
¹⁴ Department of Medicine, Indiana University, Indianapolis, Indiana, USA.
¹⁵ Department of Gastroenterology, The Queen Elizabeth Hospital, University of Adelaide, Woodville, South Australia, Australia.
¹⁶ Department of Gastroenterology, Haaglanden Medical Center, The Hague, The Netherlands.
¹⁷ Institute of Microbiology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy.
¹⁸ Department of Gastroenterology, St Mark's Hospital, Harrow, UK.
¹⁹ Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
²⁰ Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
²¹ Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology & Metabolism, Innsbruck Medical University, Innsbruck, Austria.
²² Digestive Disease Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy giovanni.cammarota@unicatt.it.

PMID: 32620549
PMCID: PMC7456726
DOI: 10.1136/gutjnl-2020-321829

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.

Keywords: colonic microflora; diarrhoeal disease.

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Conflict of interest statement

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.

Figures

**Figure 1**
Proposed treatment algorithm for patients with recurrent or refractory *Clostridioides difficile* infection (CDI) during the COVID-19 pandemic. FMT, faecal microbiota transplantation.

**Figure 2**
Proposed workflow of stool donation during the COVID-19 pandemic.

See this image and copyright information in PMC

Comment in

Enhanced donor screening for faecal microbial transplantation during COVID-19.
Parvathy SN, Lenehan JG, Fernandes R, Poutanen SM, Hota S, Maleki Vareki S, Silverman M. Parvathy SN, et al. Gut. 2021 Nov;70(11):2219-2220. doi: 10.1136/gutjnl-2021-324593. Epub 2021 Mar 31. Gut. 2021. PMID: 33789964 Free PMC article. No abstract available.

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Reorganisation of faecal microbiota transplant services during the COVID-19 pandemic

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Reorganisation of faecal microbiota transplant services during the COVID-19 pandemic

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Conflict of interest statement

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