fecal transplantation
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Indications
- recurrent* C difficile colitis
- cost effective
- may be treatment of choice[4]
- safe & effective in immunocompromised patients
- reduces risk of C difficile colitis recurrence[11]
- severe or fulminant C difficile colitis[20]
- active ulcerative colitis[9] not recommended[20]
- irritable bowel syndrome, diarrhea predominant (IBS-D)[12] (not recommended)[20]
* little evidence on efficacy for patients with refractory C difficile colitis or a first episode[7]
* effective for patients after a first or second episode of C difficile colitis[19]
* recommended only second recurrence (third episode) of C difficile colitis[20]
Contraindications
- severely immunocompromised patients[20]
- inflammatory bowel disease[20]
- irritable bowel syndrome[20]
Clinical significance
- resolution of symptoms without recurrence within 90 days (91%)[2]; 90% resolution within 30 days[17]
- 81%[3]; 90% with a 2nd fecal transplantation from a different donor [3]
- resolution of symptoms after an additional course of vancomycin with or without repeat transplant (98%)[2]
- oral non-toxigenic Clostridium difficile spores reduces recurrence of C-difficile colitis (11% vs 30%)[8]
* overall efficacy is 85%, but evidence is weak[7]
Specimen
Procedure
- donors should be tested for extended spectrum beta-lactamase producing E coli[15]
- commercial product: fecal microbiota (Rebyota)
- bowel preparation with polyethylene glycol
- performed at colonoscopy by infusing fresh donor feces into cecum[2] or duodenum[3]
- oral administation of non-toxigenic Clostridium difficile spores (3 doses)*
- fecal microbiota transplantation via oral capsules not inferior to delivery by colonoscopy for preventing recurrent infection over 12 weeks[13]
- enema of fecal microbiota weekly for 6 weeks for ulcerative colitis[9]
- frozen stool samples may be as effective as fresh samples for fecal transplantation[10]
* non-toxigenic C difficile strains lack the genes for toxin production &, thus, may colonize the gut without causing colitis[8]
Complications
- 4 of 77 patients developed new medical conditions, including peripheral neuropathy, Sjogren syndrome, rheumatoid arthritis, & idiopathic thrombocytopenic purpura (not definitively linked to fecal transplantation)[2]
- transmission of pathogenic organisms[16]
- fecal transplantation of extended spectrum beta-lactamase producing E coli may be fatal in immunocompromised patient [14.15]
Notes
- first human stool bank
More general terms
Additional terms
References
- ↑ Mattila E et al. Fecal transplantation, through colonoscopy, is effective therapy for recurrent Clostridium difficile infection. Gastroenterology 2012 Mar; 142:490. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22155369
- ↑ Jump up to: 2.0 2.1 2.2 2.3 2.4 Brandt LJ et al. Long-term follow-up of colonoscopic fecal microbiota transplant for recurrent Clostridium difficile infection. Am J Gastroenterol 2012 Jul; 107:1079. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22450732
- ↑ Jump up to: 3.0 3.1 3.2 3.3 van Nood E et al Duodenal Infusion of Donor Feces for Recurrent Clostridium difficile. New Engl J Med. January 16, 2013 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23323867 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1205037
Kelly CP Fecal Microbiota Transplantation - An Old Therapy Comes of Age. New Engl J Med. January 16, 2013 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23323865 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMe1214816 - ↑ Jump up to: 4.0 4.1 Konijeti GG et al. Cost-effectiveness of competing strategies for management of recurrent Clostridium difficile infection: A decision analysis. Clin Infect Dis 2014 Mar 31; PMID: https://www.ncbi.nlm.nih.gov/pubmed/24692533
Youngster I et al. Fecal microbiota transplant for relapsing Clostridium difficile infection using a frozen inoculum from unrelated donors: A randomized, open-label, controlled pilot study. Clin Infect Dis 2014 Apr 23; PMID: https://www.ncbi.nlm.nih.gov/pubmed/24762631 - ↑ Burke KE, Lamont JT. Fecal transplantation for recurrent Clostridium difficile infection in older adults: a review. J Am Geriatr Soc. 2013;61:1394-1398. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23869970
- ↑ Kelly CR et al. Fecal microbiota transplant for treatment of Clostridium difficile infection in immunocompromised patients. Am J Gastroenterol 2014 Jul; 109:1065 PMID: https://www.ncbi.nlm.nih.gov/pubmed/24890442
- ↑ Jump up to: 7.0 7.1 7.2 Drekonja D et al Fecal Microbiota Transplantation for Clostridium difficile Infection: A Systematic Review Ann Intern Med. 2015;162(9):630-638 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25938992 <Internet> http://annals.org/article.aspx?articleid=2288521
- ↑ Jump up to: 8.0 8.1 8.2 Gerding DN et al Administration of Spores of Nontoxigenic Clostridium difficile Strain M3 for Prevention of Recurrent C difficile Infection. A Randomized Clinical Trial. JAMA. 2015;313(17):1719-1727 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25942722 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=2281703
- ↑ Jump up to: 9.0 9.1 9.2 Moayyedi P et al. Fecal microbiota transplantation induces remission in patients with active ulcerative colitis in a randomized controlled trial. Gastroenterology 2015 Jul; 149:102 PMID: https://www.ncbi.nlm.nih.gov/pubmed/25857665
- ↑ Jump up to: 10.0 10.1 10.2 Lee CH, Steiner T, Petrof EO et al Frozen vs Fresh Fecal Microbiota Transplantation and Clinical Resolution of Diarrhea in Patients With Recurrent Clostridium difficile Infection. A Randomized Clinical Trial. JAMA. 2016;315(2):142-149. http://jama.jamanetwork.com/article.aspx?articleid=2481003
- ↑ Jump up to: 11.0 11.1 Kelly CR, Khoruts A, Staley C et al Effect of Fecal Microbiota Transplantation on Recurrence in Multiply Recurrent Clostridium difficile Infection: A Randomized Trial. Ann Intern Med. Published online 23 August 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27547925 <Internet> http://annals.org/article.aspx?articleid=2545886
Hohmann EL Are Microbial Politics Local? <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27548329 <Internet> http://annals.org/article.aspx?articleid=2545957 - ↑ Jump up to: 12.0 12.1 Johnsen PH, Hilpusch F, Cavanagh JP et al Faecal microbiota transplantation versus placebo for moderate- to-severe irritable bowel syndrome: a double-blind, randomised, placebo-controlled, parallel-group, single-centre trial. Lancet Gastroenterology and Hepatology Oct 31, 2017 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29100842 <Internet> http://thelancet.com/journals/langas/article/PIIS2468-1253(17)30338-2/fulltext
Ford AC Stool as a treatment for IBS: more questions than answers? Lancet Gastroenterology and Hepatology Oct 31, 2017 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29100844 <Internet> http://thelancet.com/journals/langas/article/PIIS2468-1253(17)30337-0/fulltext - ↑ Jump up to: 13.0 13.1 Kao D, Roach B, Silva M et al Effect of Oral Capsule- vs Colonoscopy-Delivered Fecal Microbiota Transplantation on Recurrent Clostridium difficile Infection. A Randomized Clinical Trial. JAMA. 2017;318(20):1985-1993 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29183074 https://jamanetwork.com/journals/jama/article-abstract/2664458
Rao K, MD, Young VB, MD, Malani PN. Capsules for Fecal Microbiota Transplantation in Recurrent Clostridium difficile Infection.The New Way Forward or a Tough Pill to Swallow? JAMA. 2017;318(20):1979-1980 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29183052 https://jamanetwork.com/journals/jama/article-abstract/2664435 - ↑ FDA Safety Alert. June 13, 2019 Fecal Microbiota for Transplantation: Safety Communication- Risk of Serious Adverse Reactions Due to Transmission of Multi- Drug Resistant Organisms. https://www.fda.gov/safety/medwatch-safety-alerts-human-medical-products/fecal-microbiota-transplantation-safety-communication-risk-serious-adverse-reactions-due
FDA SafetyCommunication. June 13, 2019 Important Safety Alert Regarding Use of Fecal Microbiota for Transplantation and Risk of Serious Adverse Reactions Due to Transmission of Multi-Drug Resistant Organisms. https://www.fda.gov/vaccines-blood-biologics/safety-availability-biologics/important-safety-alert-regarding-use-fecal-microbiota-transplantation-and-risk-serious-adverse - ↑ Jump up to: 15.0 15.1 DeFilipp Z, Bloom PP, Torres Soto M Drug-Resistant E. coli Bacteremia Transmitted by Fecal Microbiota Transplant. N Engl J Med. Oct 30, 2019 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31665575 https://www.nejm.org/doi/full/10.1056/NEJMoa1910437
Kassam Z, Dubois N, Ramakrishna B et al Donor Screening for Fecal Microbiota Transplantation. N Engl J Med. Oct 30, 2019 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31665572 https://www.nejm.org/doi/full/10.1056/NEJMc1913670
Blaser MJ Fecal Microbiota Transplantation for Dysbiosis - Predictable Risks. N Engl J Med. Oct 30, 2019 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31665573 https://www.nejm.org/doi/full/10.1056/NEJMe1913807 - ↑ Jump up to: 16.0 16.1 FDA Safety Alert. March 12, 2020 Fecal Microbiota for Transplantation: Safety Alert - Risk of Serious Adverse Events Likely Due to Transmission of Pathogenic Organisms. https://www.fda.gov/safety/medical-product-safety-information/fecal-microbiota-transplantation-safety-alert-risk-serious-adverse-events-likely-due-transmission
- ↑ Jump up to: 17.0 17.1 Kelly CR, Yen EF, Grinspan AM et al Fecal Microbiota Transplant is Highly Effective in Real-World Practice: Initial Results from the FMT National Registry. Gastroenterology, Oct 1, 2020 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33011173 https://www.gastrojournal.org/article/S0016-5085(20)35221-5/fulltext
- ↑ FDA Safety Alert. August 22, 2022 Safety Alert Regarding Use of Fecal Microbiota for Transplantation and Additional Safety Protections Pertaining to Monkeypox Virus. https://www.fda.gov/vaccines-blood-biologics/safety-availability-biologics/safety-alert-regarding-use-fecal-microbiota-transplantation-and-additional-safety-protections-0
- ↑ Jump up to: 19.0 19.1 Baunwall SMD et al. Faecal microbiota transplantation for first or second Clostridioides difficile infection (EarlyFMT): A randomised, double-blind, placebo-controlled trial. Lancet Gastroenterol Hepatol 2022 Dec; 7:1083. PMID: https://www.ncbi.nlm.nih.gov/pubmed/36152636 https://www.thelancet.com/journals/langas/article/PIIS2468-1253(22)00276-X/fulltext
Allegretti JR. Should faecal microbiota transplantation be used earlier in the treatment framework? Lancet Gastroenterol Hepatol 2022 Dec; 7:1062. PMID: https://www.ncbi.nlm.nih.gov/pubmed/36152634 https://www.thelancet.com/journals/langas/article/PIIS2468-1253(22)00301-6/fulltext - ↑ Jump up to: 20.0 20.1 20.2 20.3 20.4 20.5 20.6 20.7 Peery AF et al. AGA clinical practice guideline on fecal microbiota-based therapies for select gastrointestinal diseases. Gastroenterology 2024 Mar; 166:409. PMID: https://www.ncbi.nlm.nih.gov/pubmed/38395525 https://www.gastrojournal.org/article/S0016-5085(24)00041-6/fulltext
- ↑ OpenBiome: Clinician FAQs http://www.openbiome.org/clinical-faqs/