Laboratory Testing of Donors and Stool Samples for Fecal Microbiota Transplantation for Recurrent Clostridium difficile Infection

Abstract

Fecal microbiota transplantation is an efficacious and inexpensive therapy for recurrent Clostridium difficile infection, yet its safety is thought to depend on appropriate fecal donor screening. FDA guidance for regulation of this procedure is in flux, but screening and manufacture of fecal material from asymptomatic donors present many challenges to clinical laboratories. This minireview summarizes FDA regulatory changes, principles of donor selection, and recommended laboratory screening practices for fecal microbiota transplantation.

Fecal Microbiota Transplant for Multidrug-Resistant Organism Decolonization Administered During Septic Shock

“…Linezolid dependence was not observed in the conditions tested ( Figure S1), suggesting a variable phenotype potentially dependent on previous linezolid exposure, as has been described for some strains. 5 The 3 Greek and Turkish isolates presented the same ribosomal mutations, MIC values for linezolid and tedizolid, and the same pulsotype A ( Figure S2; Table 1). …”

“…On day 2 of his ICU stay, upon FDA approval of eIND application, FMT was performed via PEG tube (18 French halyard gastrostomy tube). 5 Due to ileus noted on imaging, stool was administered slowly; 20 cm 3 of stool was administered at 09:25 AM over 5 minutes followed by an additional 10 cm 3 in bolus form at 10:00 AM. During administration, vital signs and ventilator requirements remained stable with no signs of aspiration noted.…”

“…However, FDA approval of an investigational new drug (IND) application is required for clinical or research use for applications other than RCDI. 5 In this case, given the family's willingness to attempt FMT and subsequent approval of the eIND from the…”

“…1 The LRSE-ST22 isolates have been associated with infection and colonization cases in Spain, France, Germany, and, particularly, Greece, and most of these LRSE-ST22 arise after treatment with linezolid. [1][2][3][4][5][6][7] In this study, we aimed to characterize the first methicillin-and linezolid-resistant S. epidermidis from a patient without previous linezolid exposure in Turkey and to assess its genetic similarity to the close geographical S. epidermidis from Greece.…”

“…Linezolid dependence was evaluated because it is a possible factor contributing to the emergence of ST22-S. epidermidis in Greece. 5 The Turkish LRSE and 2 LRSE-ST22 isolates from a high number of patients under linezolid therapy in 2 Greek regions (Patris and Athens) during 2008-2012 2,3 were compared by performing additional experiments not available in those studies: PFGE, ribosomal protein mutations, minimum inhibitory concentration (MIC)-tedizolid.…”