Safety of fecal microbiota transplantation for Clostridioides difficile infection focusing on pathobionts and SARS-CoV-2

Abstract

Clostridioides difficile infection (CDI) is a consequence of flagrant use of antibiotics, an aging population with increasing comorbidities, and increased hospitalizations. The treatment of choice for CDI is antibiotics (vancomycin or fidaxomicin), with a possibility of recurrent CDI despite lack of additional risk factors for CDI. For the last 10 years, fecal microbiota transplantation (FMT) has emerged as a promising therapy for recurrent CDI, with success rates of over 85% compared with less than 50% with antibiotics for multiple recurrent CDI. Along with the success of FMT, several adverse and serious adverse events with FMT have been reported. These range from self-limiting abdominal pain to death due to severe sepsis. This review focuses on the safety of FMT, emphasizing the reports of transmission of pathobionts like extended-spectrum beta lactamase Escherichia coli and Shiga toxin-producing E. coli. The severe acute respiratory syndrome coronavirus-2 is a potential pathogen that could be transmitted via FMT during the COVID-19 pandemic. The challenges faced by clinicians for donor screening, clinical trials, and other aspects of FMT during the pandemic are discussed.

The potential utility of fecal (or intestinal) microbiota transplantation in controlling infectious diseases

“…Although the administration of FMT is becoming more refined in terms of the availability and ease of capsulized administration, with further understanding of mechanisms of actions, refined bacterial consortiums that could potentially be personalized to target specific organisms would be of greater value, and would overcome the potential risks identified with FMT administration. 168 Manipulation of the microbiota is an attractive target for infections due to the global effort to reduce the use of antibiotics and the worldwide antimicrobial resistance crisis; however, large scale RCTs are needed to confirm the true utility in each of these different conditions.…”

New hope for Parkinson's disease treatment: Targeting gut microbiota

“…At present, FMT has been most commonly used to study the treatment of Clostridium difficile. 167 In addition, FMT also appears to play a pivotal role in the interventional treatment of neurological disorders.…”

“…Fecal transplantation (FMT) is a procedure in which a healthy donor's stool is placed into the gastrointestinal tract of another patient to restore normal bacterial composition by altering the host's dysbiosis. At present, FMT has been most commonly used to study the treatment of Clostridium difficile 167 . In addition, FMT also appears to play a pivotal role in the interventional treatment of neurological disorders.…”

“…At present, FMT has been most commonly used to study the treatment of Clostridium difficile . 167 In addition, FMT also appears to play a pivotal role in the interventional treatment of neurological disorders. For example, rapid improvement in AD symptoms was shown after FMT treatment for recurrent Clostridium difficile infection.…”

Clostridioides difficile infection: curbing a difficult menace

“…Microbiome restoration with FMT achieves high cure rates, but the practice is heterogeneous and there have been adverse events noted with infection transmission as outlined. In addition, Yadav and Khanna 12 outline the safety of FMT for CDI focusing on pathobionts and the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Common adverse events are mostly gastrointestinal in nature with high rates of diarrhea and postinfection irritable bowel syndrome.…”