Faecal microbiota transplantation: a review
Holly A Sinclair A C and Paul Chapman A B
+ Author Affiliations
- Author Affiliations
A Infectious Diseases Department, Royal Brisbane and Women’s Hospital, Herston, Qld, Australia
B QIMR Berghofer Medical Research Institute, Herston, Qld, Australia
C Tel.: +61 7 3646 8111, Email: holly.sinclair@health.qld.gov.au
Microbiology Australia 41(2) 65-69 https://doi.org/10.1071/MA20019
Published: 21 May 2020
Abstract
Faecal microbiota transplantation (FMT) is the transfer of human faeces from a healthy donor to a recipient with a disease associated with gut dysbiosis. Here we review faecal microbiota transplantation as a treatment for Clostridioides difficile infection (CDI) and other conditions including decolonisation of multiresistant organisms. Donor selection and screening, adverse events, processing, administration and regulation of FMT are discussed.
References
[1] Czepiel, J. et al. (2019) Clostridium difficile infection Eur. J. Clin. Microbiol. Infect. Dis. 38, 1211–1221.| Clostridium difficile infectionCrossref | GoogleScholarGoogle Scholar | 30945014PubMed |
[2] Eiseman, B. et al. (1958) Fecal enema as an adjunct in the treatment of pseudomembranous enterocolitis. Surgery 44, 854–859.
| 13592638PubMed |
[3] Woodworth, M.H. et al. (2017) Challenges in fecal donor selection and screening for fecal microbiota transplantation: a review. Gut Microbes 8, 225–237.
| Challenges in fecal donor selection and screening for fecal microbiota transplantation: a review.Crossref | GoogleScholarGoogle Scholar | 28129018PubMed |
[4] Staley, C. et al. (2016) Complete microbiota engraftment is not essential for recovery from recurrent Clostridium difficile infection following fecal microbiota transplantation. MBio 7, e01965-16.
| Complete microbiota engraftment is not essential for recovery from recurrent Clostridium difficile infection following fecal microbiota transplantation.Crossref | GoogleScholarGoogle Scholar | 27999162PubMed |
[5] Shankar, V. et al. (2014) Species and genus level resolution analysis of gut microbiota in Clostridium difficile patients following fecal microbiota transplantation. Microbiome 2, 13.
| Species and genus level resolution analysis of gut microbiota in Clostridium difficile patients following fecal microbiota transplantation.Crossref | GoogleScholarGoogle Scholar | 24855561PubMed |
[6] Jalanka, J. et al. (2016) Long-term effects on luminal and mucosal microbiota and commonly acquired taxa in faecal microbiota transplantation for recurrent Clostridium difficile infection. BMC Med. 14, 155.
| Long-term effects on luminal and mucosal microbiota and commonly acquired taxa in faecal microbiota transplantation for recurrent Clostridium difficile infection.Crossref | GoogleScholarGoogle Scholar | 27724956PubMed |
[7] Trubiano, J.A. et al. (2016) Australasian Society of Infectious Diseases updated guidelines for the management of Clostridium difficile infection in adults and children in Australia and New Zealand. Intern. Med. J. 46, 479–493.
| Australasian Society of Infectious Diseases updated guidelines for the management of Clostridium difficile infection in adults and children in Australia and New Zealand.Crossref | GoogleScholarGoogle Scholar | 27062204PubMed |
[8] van Nood, E. et al. (2013) Duodenal infusion of donor feces for recurrent Clostridium difficile. N. Engl. J. Med. 368, 407–415.
| Duodenal infusion of donor feces for recurrent Clostridium difficile.Crossref | GoogleScholarGoogle Scholar | 23323867PubMed |
[9] Cammarota, G. et al. (2015) Randomised clinical trial: faecal microbiota transplantation by colonoscopy vs. vancomycin for the treatment of recurrent Clostridium difficile infection. Aliment. Pharmacol. Ther. 41, 835–843.
| Randomised clinical trial: faecal microbiota transplantation by colonoscopy vs. vancomycin for the treatment of recurrent Clostridium difficile infection.Crossref | GoogleScholarGoogle Scholar | 25728808PubMed |
[10] Quraishi, M.N. et al. (2017) Systematic review with meta-analysis: the efficacy of faecal microbiota transplantation for the treatment of recurrent and refractory Clostridium difficile infection. Aliment. Pharmacol. Ther. 46, 479–493.
| Systematic review with meta-analysis: the efficacy of faecal microbiota transplantation for the treatment of recurrent and refractory Clostridium difficile infection.Crossref | GoogleScholarGoogle Scholar | 28707337PubMed |
[11] (2019) eTG complete. www.tg.org.au
[12] Mullish, B.H. et al. (2018) The use of faecal microbiota transplant as treatment for recurrent or refractory Clostridium difficile infection and other potential indications: joint British Society of Gastroenterology (BSG) and Healthcare Infection Society (HIS) guidelines. J. Hosp. Infect. 100, S1–S31.
| The use of faecal microbiota transplant as treatment for recurrent or refractory Clostridium difficile infection and other potential indications: joint British Society of Gastroenterology (BSG) and Healthcare Infection Society (HIS) guidelines.Crossref | GoogleScholarGoogle Scholar | 30173851PubMed |
[13] Cammarota, G. et al. (2017) European consensus conference on faecal microbiota transplantation in clinical practice. Gut 66, 569–580.
| European consensus conference on faecal microbiota transplantation in clinical practice.Crossref | GoogleScholarGoogle Scholar | 28087657PubMed |
[14] McDonald, L.C. et al. (2018) Clinical practice guidelines for Clostridium difficile infection in adults and children: 2017 update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin. Infect. Dis. 66, 987–994.
| Clinical practice guidelines for Clostridium difficile infection in adults and children: 2017 update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA).Crossref | GoogleScholarGoogle Scholar | 29562266PubMed |
[15] Baxter, M. and Colville, A. (2016) Adverse events in faecal microbiota transplant: a review of the literature. J. Hosp. Infect. 92, 117–127.
| Adverse events in faecal microbiota transplant: a review of the literature.Crossref | GoogleScholarGoogle Scholar | 26803556PubMed |
[16] van Beurden, Y.H. et al. (2017) Complications, effectiveness, and long term follow-up of fecal microbiota transfer by nasoduodenal tube for treatment of recurrent Clostridium difficile infection. United European Gastroenterol. J. 5, 868–879.
| Complications, effectiveness, and long term follow-up of fecal microbiota transfer by nasoduodenal tube for treatment of recurrent Clostridium difficile infection.Crossref | GoogleScholarGoogle Scholar | 29026601PubMed |
[17] Baxter, M. et al. (2015) Fatal aspiration pneumonia as a complication of fecal microbiota transplant. Clin. Infect. Dis. 61, 136–137.
| Fatal aspiration pneumonia as a complication of fecal microbiota transplant.Crossref | GoogleScholarGoogle Scholar | 25805303PubMed |
[18] Friedman-Korn, T. et al. (2018) Fecal transplantation for treatment of Clostridium difficile infection in elderly and debilitated patients. Dig. Dis. Sci. 63, 198–203.
| Fecal transplantation for treatment of Clostridium difficile infection in elderly and debilitated patients.Crossref | GoogleScholarGoogle Scholar | 29134299PubMed |
[19] DeFilipp, Z. et al. (2019) Drug-resistant E. coli bacteremia transmitted by fecal microbiota transplant. N. Engl. J. Med. 381, 2043–2050.
| Drug-resistant E. coli bacteremia transmitted by fecal microbiota transplant.Crossref | GoogleScholarGoogle Scholar | 31665575PubMed |
[20] Luo, Y. et al. (2020) Fecal microbiota transplantation for Clostridioides difficile in high-risk older adults is associated with early recurrence. Dig. Dis. Sci. , .
| Fecal microbiota transplantation for Clostridioides difficile in high-risk older adults is associated with early recurrence.Crossref | GoogleScholarGoogle Scholar | 32078714PubMed |
[21] Jalanka, J. et al. (2018) The long-term effects of faecal microbiota transplantation for gastrointestinal symptoms and general health in patients with recurrent Clostridium difficile infection. Aliment. Pharmacol. Ther. 47, 371–379.
| The long-term effects of faecal microbiota transplantation for gastrointestinal symptoms and general health in patients with recurrent Clostridium difficile infection.Crossref | GoogleScholarGoogle Scholar | 29226561PubMed |
[22] Costello, S.P. et al. (2016) Establishing a fecal microbiota transplant service for the treatment of Clostridium difficile infection. Clin. Infect. Dis. 62, 908–914.
| Establishing a fecal microbiota transplant service for the treatment of Clostridium difficile infection.Crossref | GoogleScholarGoogle Scholar | 26628567PubMed |
[23] Haifer, C. et al. (2020) Australian consensus statements for the regulation, production and use of faecal microbiota transplantation in clinical practice. Gut 69, 801–810.
| Australian consensus statements for the regulation, production and use of faecal microbiota transplantation in clinical practice.Crossref | GoogleScholarGoogle Scholar | 32047093PubMed |
[24] Papanicolas, L.E. et al. (2019) Bacterial viability in faecal transplants: which bacteria survive? EBioMedicine 41, 509–516.
| Bacterial viability in faecal transplants: which bacteria survive?Crossref | GoogleScholarGoogle Scholar | 30796005PubMed |
[25] Costello, S.P. et al. (2015) Faecal microbiota transplant for recurrent Clostridium difficile infection using long-term frozen stool is effective: clinical efficacy and bacterial viability data. Aliment. Pharmacol. Ther. 42, 1011–1018.
| Faecal microbiota transplant for recurrent Clostridium difficile infection using long-term frozen stool is effective: clinical efficacy and bacterial viability data.Crossref | GoogleScholarGoogle Scholar | 26264455PubMed |
[26] Staley, C. et al. (2017) Successful resolution of recurrent Clostridium difficile infection using freeze-dried, encapsulated fecal microbiota; pragmatic cohort study. Am. J. Gastroenterol. 112, 940–947.
| Successful resolution of recurrent Clostridium difficile infection using freeze-dried, encapsulated fecal microbiota; pragmatic cohort study.Crossref | GoogleScholarGoogle Scholar | 28195180PubMed |
[27] Jiang, Z.D. et al. (2017) Randomised clinical trial: faecal microbiota transplantation for recurrent Clostridum difficile infection – fresh, or frozen, or lyophilised microbiota from a small pool of healthy donors delivered by colonoscopy. Aliment. Pharmacol. Ther. 45, 899–908.
| Randomised clinical trial: faecal microbiota transplantation for recurrent Clostridum difficile infection – fresh, or frozen, or lyophilised microbiota from a small pool of healthy donors delivered by colonoscopy.Crossref | GoogleScholarGoogle Scholar | 28220514PubMed |
[28] Jiang, Z.D. et al. (2018) Safety and preliminary efficacy of orally administered lyophilized fecal microbiota product compared with frozen product given by enema for recurrent Clostridium difficile infection: a randomized clinical trial. PLoS One 13, e0205064.
| Safety and preliminary efficacy of orally administered lyophilized fecal microbiota product compared with frozen product given by enema for recurrent Clostridium difficile infection: a randomized clinical trial.Crossref | GoogleScholarGoogle Scholar | 30388112PubMed |
[29] Kao, D. et al. (2017) Effect of Oral capsule- vs colonoscopy-delivered fecal microbiota transplantation on recurrent Clostridium difficile infection: a randomized clinical trial. JAMA 318, 1985–1993.
| Effect of Oral capsule- vs colonoscopy-delivered fecal microbiota transplantation on recurrent Clostridium difficile infection: a randomized clinical trial.Crossref | GoogleScholarGoogle Scholar | 29183074PubMed |
[30] Ianiro, G. et al. (2018) Efficacy of different faecal microbiota transplantation protocols for Clostridium difficile infection: a systematic review and meta-analysis. United European Gastroenterol. J. 6, 1232–1244.
| Efficacy of different faecal microbiota transplantation protocols for Clostridium difficile infection: a systematic review and meta-analysis.Crossref | GoogleScholarGoogle Scholar | 30288286PubMed |
[31] Kelly, C.R. et al. (2017) The AGA’s Fecal Microbiota Transplantation National Registry: an important step toward understanding risks and benefits of microbiota therapeutics. Gastroenterology 152, 681–684.
| The AGA’s Fecal Microbiota Transplantation National Registry: an important step toward understanding risks and benefits of microbiota therapeutics.Crossref | GoogleScholarGoogle Scholar | 28143773PubMed |
[32] Cammarota, G. et al. (2019) International consensus conference on stool banking for faecal microbiota transplantation in clinical practice. Gut 68, 2111–2121.
| International consensus conference on stool banking for faecal microbiota transplantation in clinical practice.Crossref | GoogleScholarGoogle Scholar | 31563878PubMed |
[33] Laffin, M. et al. (2017) Fecal microbial transplantation as a therapeutic option in patients colonized with antibiotic resistant organisms. Gut Microbes 8, 221–224.
| Fecal microbial transplantation as a therapeutic option in patients colonized with antibiotic resistant organisms.Crossref | GoogleScholarGoogle Scholar | 28059612PubMed |
[34] Huttner, B.D. et al. (2019) A 5-day course of oral antibiotics followed by faecal transplantation to eradicate carriage of multidrug-resistant Enterobacteriaceae: a randomized clinical trial. Clin. Microbiol. Infect. 25, 830–838.
| A 5-day course of oral antibiotics followed by faecal transplantation to eradicate carriage of multidrug-resistant Enterobacteriaceae: a randomized clinical trial.Crossref | GoogleScholarGoogle Scholar | 30616014PubMed |
[35] Tacconelli, E. et al. (2019) ESCMID-EUCIC clinical guidelines on decolonization of multidrug-resistant Gram-negative bacteria carriers. Clin. Microbiol. Infect. 25, 807–817.
| ESCMID-EUCIC clinical guidelines on decolonization of multidrug-resistant Gram-negative bacteria carriers.Crossref | GoogleScholarGoogle Scholar | 30708122PubMed |
