Faecal Microbiota Transplantation for the Treatment of Recurrent Clostridium difficile Infection

Current Promise and Future Needs

Mark J. Koenigsknecht; Vincent B. Young


Curr Opin Gastroenterol. 2013;29(6):628-632. 

In This Article

Progress Has Been Made in the Standardization of Faecal Microbiota Transplantation Preparation

In previous studies, faeces for transplantation has generally been donated by a family member of the patient. This material is then screened for enteric pathogens (such as C. difficile, Helicobacter pylori, Giardia and Cryptosporidium) and viruses (such as hepatitis and HIV). The faeces is then diluted (in saline, milk or water) and homogenized with a blender. Particulates are then filtered out and the faeces is ready for transplantation. The procedure of obtaining, screening and processing the faeces sample for FMT, dosage and number of treatments has varied;[20,21] however, it should be noted that even with this variation, the FMT still resulted in greater than 80% resolution of recurrent CDI.[21]

The use of individual donors for FMT has prompted some investigators to determine whether prescreened and stored faeces could be used for treatment of recurrent CDI. A recent study by Hamilton et al.[24] described a protocol for the processing and freezing of donor faeces that now allows for universal donors and more accessibility to donor faeces. Importantly, this standardization protocol did not lose any apparent efficacy when used for treatment of recurrent CDI even though the donor faeces was frozen prior to FMT. The standardization process is important in several ways. First, it showed that a standardized, volunteer faeces donation programme was accepted for use by the patients. A recent survey assessing patient perceptions for FMT to treat ulcerative colitis found that almost 50% of patients preferred donor faeces from a family member as opposed to whomever their doctor recommended.[25] Using donor faeces from a family member is the most common approach to obtaining donor faeces and this study showed that patients were willing to use a standardized, volunteer faeces donation programme. Second, it shows a protocol to cryopreserve the faeces that is effective in treating recurrent CDI. This allows the faeces to be processed in advance, stored and can be shipped to other hospitals when needed. This will greatly increase the availability of donor faeces leading to more accessibility for this treatment. Finally, using universal donors and creating multiple preps is a cost-effective means of FMT due to a decreased cost in screening on the universal donor faeces as opposed to having to screen each individual donor.[26]