Fecal microbiota transplant has become more acceptable as a therapeutic for recurrent Clostridium difficile infection. The FDA has an enforcement discretion policy for practitioner's performing this therapy, which includes informed consent for this experimental treatment. This manuscript describes a typical procedure that can be followed that includes the important aspects of this preparation and treatment.

Clostridium difficile infection (CDI) is a leading cause of nosocomial infection and isassociated with significant morbidity and mortality. Immunocompromised (IC) patients are particularly at higher risk. Recurrence rates of up to 60 % have been reported after the third episode despite treatment with antibiotics. Recent published reports of fecal microbiota transplantation (FMT) in the IC population have shed light that the procedure proves to be effective and safe. No studies that compare the efficacy and adverse event rate of FMT between IC and non-IC patients currently exist The aim of our study is to compare the response and serious adverse event (SAE) rates of FMT for recurrent or refractory CDI (RCDI) between IC patients and non-IC patients.We performed a single-center retrospective study on patients who received FMT for RCDI in a single tertiary care center. Donor stool was obtained from a universal donor, friend, or relative. We used a standardized protocol for preparation of stool used for FMT. Patients received FMT through the upper gastrointestinal route or by colonoscopy. Those who failed initial FMT were eligible to receive additional FMT.Patients were considered IC as a result of one or more of the following: HIV infection (any CD4 count), AIDS-defining diagnosis or CD4<200/mm 3 , inherited or primary immune disorders, active malignancy, and immunodeficient or immunosuppressed from a medical condition/medication including current or recent (<3 months) treatment with anti-neoplastic

FMT is a generally safe and effective treatment option for older adults with CDI.

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