Clinical Practice and Infrastructure Review of Fecal Microbiota Transplantation for Clostridium difficile Infection

Abstract

A substantial proportion of Clostridium difficile infection (CDI) cases recur after completion of antibiotic therapy, and antibiotic cure rates diminish with each recurrence of CDI. Fecal microbiota transplantation (FMT) is an effective therapy for recurrent FMT, which otherwise requires prolonged or indefinite antibiotic treatment. FMT is performed by introducing the fecal microbial community obtained from a healthy donor or pool of donors into the stomach, small intestine, or colon of a patient with CDI. Multiple clinical trials support the usefulness of FMT in treating recurrent CDI, and CDI treatment guidelines now include consideration of FMT at the third CDI recurrence. However, there remain challenges to incorporating FMT into clinical practice. First, methods of fecal bacterial community processing vary, as do methods of FMT administration. Second, the optimal dosing strategy and expected benefit of FMT for refractory CDI, particularly for severe and severe complicated cases, are uncertain. Third, the US Food and Drug Administration (FDA) considers FMT an investigational treatment. Fourth, insurance reimbursement for FMT usually falls short of FMT administration costs. In the setting of rising C difficile incidence and growing evidence for FMT efficacy, the demand for FMT has increased. However, uncertainty surrounding optimal FMT preparation and administration methods, FDA oversight, and insurance reimbursement presently limits the clinical practice of FMT.

Oral faecal microbiota transplantation for the treatment of Clostridium difficile-associated diarrhoea in a dog: a case report

“…The present case report demonstrated that C. difficile antigen and toxin A&B genes and proteins turned into negative, and stool consistency and frequency and faecal blood and mucus became normal after oral FMT in a dog with large bowel diarrhoea. Successful clinical outcomes of FMT for recurrent CDI have been reported in humans [5][6][7] and a marmoset [3]. These findings collectively suggest that correction of gut microbiota with FMT can be a useful treatment option for C. difficile-associated diarrhoea across animal species.…”

“…The pathogenesis of CDI is well established in humans, and involves toxin production by colonic C. difficile and depletion of non-C. difficile colonic microbiota [5]. However, it is still controversial whether C. difficile plays a pathological role in the development of diarrhoea in dogs [8].…”

“…FMT can be performed via the upper or lower GI tract [5]. Theoretical guidelines for FMT have been recently proposed in dogs and cats [16].…”

“…Faecal microbiota transplantation (FMT) is a treatment option performed by introducing faecal microbiota obtained from a healthy donor into the gastrointestinal (GI) tract of a recipient [4,5]. Successful clinical outcomes of FMT for recurrent CDI have been reported in humans [5][6][7] and a marmoset [3]. However, it has been unclear whether FMT was effective for the treatment of C. difficile-associated diarrhoea in dogs.…”

The Design, Synthesis, and Characterizations of Spore Germination Inhibitors Effective against an Epidemic Strain of Clostridium difficile

“…21 Finally, fecal transplantation for CDI relapse has been shown to be an effective, nonantibiotic therapy, although its use is limited in the US. 22,23 …”