BEIJING, Nov. 24, 2021 /PRNewswire/ — Our gut houses billions of different microbes, each serving its purpose to keep our gut functioning and healthy. The Clostridioides difficile (C. diff) infection is caused by an excess of bad microbes in the gut along with a deficiency of good ones. Antibiotics are a common treatment for this infection, but recently another effective treatment has begun to be routinely used: washed microbiota transplantation (WMT).
In WMT, microbes are extracted from the fecal matter of a healthy donor; purified via multiple cycles of automated washing, centrifuging, and filtration; enriched for good bacteria; and transplanted into the patient’s gut. WMT is a relatively new procedure for fecal microbiota transplantation (FMT), and its protocols differ from those for performing the traditional crude FMT, which is based on manual preparation. Standardization of this FMT is needed to improve clinical practice overall and enable efficient multi-center clinical trials.
So, in 2019, a group of medical professionals, comprising 28 experts from 22 hospitals or institutes in 15 cities in China, gathered to arrive at a consensus on the procedure. The proceedings of this gathering are reported in an article published on 5 October 2020 in the Chinese Medical Journal.
This WMT panel was led by Professor Fa-Ming Zhang from the Medical Center for Digestive Diseases, Second Affiliated Hospital of Nanjing Medical University, China. Speaking of the proceedings, Dr. Zhang says, "Based on their expertise, each member was assigned to one of five groups: donor screening; washing protocol, storing, and transport; patient preparation; delivery decision; and safety and management."
The panel was given 31 statements describing the protocols with best available evidence backing. These they assessed in terms of quality of evidence and strength of recommendations. "After two rounds of voting and editing and a face-to-face overall discussion, a consensus was reached," Dr. Zhang says. All statements had more than 80% consensus.
It was agreed upon that donor screening should involve donor education, testing for other infections, and an interview to rule out any risk factors; washing, storing, and transport should focus on improving quality, limiting contamination, and keeping the suspension fresh; patient preparation should include stopping antibiotics in advance and testing for other infections; delivery routes should depend on the condition being treated, patient general health, and patient choice; the procedure should always be managed by WMT-trained physicians in level 2 facilities; and samples should be archived for recording.
The panel also outlined the general steps for washed microbiota suspension preparation, including sample collection protocols, washing protocols, sample amount, and clinical dose.
This consensus paves the way for further advancement in the WMT procedure and improvement in its treatment efficacy. Hopefully, they will translate into guidelines for practice soon and benefit the medical and patient community immensely.
Reference
Title of original paper: Nanjing consensus on methodology of washed microbiota transplantation
Journal: Chinese Medical Journal
DOI: https://doi.org/10.1097/CM9.0000000000000954
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SOURCE Chinese Medical Journal
