Fecal Microbiota Transplantation

Breaking the Chain of Recurrent C. difficile Infection

Amy Marinski, MSN, RN, CCRN, CNL


Am Nurs Today. 2013;8(6) 

In This Article

Reviving an Old Treatment

An old treatment may be the answer to the current MR-CDI epidemic. Fecal microbiota transplantation (FMT), also called fecal bacteriotherapy, was described as long ago as the 17th century. The similar veterinary practice of transfaunation (transfer of symbiotic fauna from one host to another) was used to cure colitis in farm animals. In 1958, before C. difficile was discovered as a causative pathogen, FMT was used successfully to treat patients with antibiotic-associated pseudomembranous colitis. (See the box below.)

Clostrodium difficile commonly causes an inflammation of the colon called pseudomembranous colitis. This image shows yellow pseudomembranes on the wall of the colon.

More than 500 bacterial species inhabit the intestinal tract, creating a symbiotic environment within this microbial organ. Scientists are starting to recognize this symbiosis as an important element in immunity; the gut provides protection from pathogens and promotes epithelial-cell proliferation and nutrient production and metabolism.

C. difficile flourishes in the environment around us. Intestinal flora protect us from it, but antibiotics can disturb the balance, allowing C. difficile to proliferate, overgrow, and cause infection. FMT reconstitutes the normal intestinal flora, which explains its overwhelming success in treating CDI.

Candidates for FMT include patients who:

  • have had three episodes of recurring CDI with 6 to 8 weeks of antibiotic failure, or two recurrent CDIs requiring hospitalization

  • have moderate CDI but haven't responded to antibiotic therapy

  • have severe colitis from C. difficile and are decompensating and unresponsive to antibiotics.

Ineligible patients typically include those receiving immunosuppressant agents or chemotherapy, those who've had a recent bone marrow transplant, and those with advanced HIV/AIDS. Patients with toxic megacolon aren't eligible for FMT because that condition is a surgical emergency.

FMT isn't limited to patients with CDI. It also has been used successfully in patients with chronic severe constipation and in those with inflammatory bowel disease (such as Crohn's disease or ulcerative colitis) who've failed other therapies.