What is a fecal microbiota transplant (FMT)?

From the Guidelines

Fecal transplant, also known as fecal microbiota transplantation (FMT), is a medical procedure where stool from a healthy donor is transferred into the intestinal tract of a recipient to restore beneficial gut bacteria, primarily used to treat recurrent Clostridioides difficile (C. diff) infections that haven't responded to standard antibiotic treatments. The procedure involves processing donor stool to create a liquid solution that can be delivered via colonoscopy, enema, nasogastric tube, or capsules taken orally [ 1 ]. Before undergoing FMT, patients typically complete a course of antibiotics to reduce existing C. diff bacteria, followed by the transplant procedure itself [ 1 ]. The transplanted healthy bacteria help reestablish a balanced gut microbiome, which prevents C. diff from regrowing and causing further infection. Some key points to consider when using FMT include:

• Offering antibiotics alone in preference to FMT as an initial treatment for CDI [ 1 ]
• Considering FMT for a first recurrence of CDI or as an adjunct to antibiotics in refractory CDI [ 1 ]
• Ensuring that FMT is preceded by the treatment of CDI with appropriate antibiotics for at least 10 days [ 1 ] Success rates for treating recurrent C. diff with FMT are high, around 80-90% [ 1 ]. While primarily used for C. diff infections, researchers are investigating its potential for other conditions like inflammatory bowel disease, irritable bowel syndrome, and metabolic disorders, though these applications remain experimental [ 1 ].

From the Research

Definition of Fecal Transplant

• Fecal microbiota transplantation (FMT) is a method to directly change the recipient's gut microbiota to normalize the composition and gain a therapeutic benefit 2.
• FMT is the process of transplanting stool from a healthy donor into the gut of a patient for therapeutic purposes 3.

Applications of Fecal Transplant

• FMT has been highly regarded since 2013 for treating recurrent and refractory Clostridium difficile infection 2.
• The range of FMT applications has extended rapidly and broadly not only in gastrointestinal disorders, but also in extra-gastrointestinal diseases 2.
• FMT shows promise as salvage therapy for critically-ill, refractory CDI patients who are poor surgical candidates 3.
• Ulcerative colitis was more recently identified as a potential treatment target for FMT 3.

Procedure and Safety

• Donor selection with questionnaire, interview, blood tests, and stool examinations should be strictly performed before FMT to reduce and prevent occurrence of any adverse events 2.
• Step-by-step cautious fecal and recipient preparation along with adequately choosing delivery methods based on individual clinical situations are key points of the FMT process 2.
• Current evidence deems FMT as a generally safe therapeutic method with few adverse effects, but the long-term outcomes of FMT have not been completely elucidated 2.
• No significant adverse events were observed in either of the study groups in a randomized clinical trial comparing FMT with vancomycin regimen for the treatment of recurrent C. difficile infection 4.

Efficacy

• FMT was significantly more effective than vancomycin regimen for the treatment of recurrent C. difficile infection in a randomized clinical trial 4.
• FMT using colonoscopy to infuse faeces was significantly more effective than fidaxomicin or vancomycin based on end points of clinical and microbiological resolution or clinical resolution alone in a randomized trial 5.
• Cure rates of FMT for the prevention of multiply recurrent Clostridioides difficile infection (CDI) approach 90% 3.