OBJECTIVES: Fecal microbiota transfer (FMT) modulates the gastrointestinal microbiota. The use in recurrent Clostridioides difficile infection (rCDI) is established throughout Europe and recommended in international guidelines. In Germany, a sharp decline in use of FMT since 2020 was reported lately. Tighter regulatory requirements and the Covid-19 pandemic were suspected to be the reasons. Now that the Covid pandemic has subsided, it is to be investigated whether the implementation of FMT is increasing again or whether the changed regulatory requirements may be the main reason for the decrease.

METHODS: Reports of the Federal Statistical Office (DESTATIS), the Institute for Hospital Remuneration (InEK), and hospital quality reports 2015-2023 were examined for FMT coding.

RESULTS: Between 2015 and 2023 coding of 1,827 FMT procedures by 180 hospitals. From 2016 to 2018, this was a mean of 293 (274-313) FMT annually, followed by a steady decline in subsequent years to 98 FMT in 2022 and 84 FMT (-73.2% from peak) in 2023. In 2022 only 24 (-67.6% from peak) hospitals performed FMT.

From 2015 to 2021 patients undergoing with FMT were 57.7% female, median age 74 years FMT was applied colonoscopically in 72.2%. In 2022 and 2023 were 55.5% female, median age 69 years, colonoscopic application in 63.1%. CDI was the primary diagnosis in 86.8% (2023: 81.0%) of cases, followed by ulcerative colitis in 7.6%.

CONCLUSIONS: In Germany, FMT was used less frequently than in the European comparison. New regulations regarding the preparation and application of FMT and the Covid-19 pandemic led to a sharp decrease in performance overall and number of applying hospitals. This analysis confirms that with overcoming Covid-19 the frequency of FMT is still dropping, putting the finger on the new regulations. Demographics of the patients, underlying diseases and the type of application have only slightly changed.