Expert opinion on fecal microbiota transplantation for the treatment of Clostridioides difficile infection and beyond

ABSTRACT

Introduction: Fecal microbiota transplantation (FMT) is a procedure involving transfer of stool from a healthy donor into the intestinal tract of a diseased recipient to restore intestinal microbial composition and functionality. FMT’s tremendous success in recurrent and refractory Clostridioides difficile infection (CDI) catalyzed gut microbiota research and opened the door to microbiome-based therapy for various gastrointestinal and other disorders.

Areas covered: We used PubMed search engine to identify significant publications in the field of CDI and FMT. Here we present an overview of the current literature on FMT’s use for recurrent, non-severe, severe, and fulminant CDI and on promising future application.

Expert opinion: FMT as the best tool for treatment of antibiotic-refractory CDI has gained immense popularity over the last decade. The future of gut microbiota-based therapy should include oral formulations that contain well-described ingredients in effective doses, clear mechanism of action, and excellent safety profile.

KEYWORDS:

• Clostridioides difficile
• C. diff
• C. diff colitis
• fulminant colitis
• fecal microbiota transplantation
• colonoscopy
• colectomy
• dysbiosis
• microbiota

Article highlights

• Current indications of fecal microbiota transplant (FMT) include recurrent, severe, and fulminant Clostridioides difficile infection (CDI) refractory to antimicrobial therapy.

• Several clinical trials suggest benefit of FMT for ulcerative colitis.

• Ongoing research studies examine the role of FMT in other gastrointestinal and non-gastrointestinal diseases.

• 101 of FMT including stool donor selection and screening, stool preparation, routes of administration, patient selection, discharge instructions, outcome and adverse event monitoring.

• Future of FMT and microbiome modulation-based therapies.

This box summarizes key points contained in the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.