Advances in Microbiome-Based Therapies for Recurrent C difficile Infection - Episode 4

Use of Fecal Microbiota Transplantation (FMT) Treatment in CDI

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Candace Cotto, RN, and Andrew Skinner, MD, discuss the challenges of traditional fecal microbiota transplantation (FMT) in treatment of CDI.

Stuart Johnson, MD: Candace, what is the rationale behind FMT treatment and when is FMT recommended?

Candace Cotto, RN: The rationale behind FMT is to restore the patient's microbiome back to a healthy microbiome. And the recommendations are based on the deficiencies of the microbiome and what it was deficient in. And that is a new, healthy microbiome via FMT.

Stuart Johnson, MD: And when is it recommended?

Candace Cotto, RN: At this point? At the second recurrence.

Stuart Johnson, MD: Those would be the ACG [American College of Gastroenterology] guidelines.

Candace Cotto, RN: ACG guidelines.

Stuart Johnson, MD: Right. And the IDSA [Infectious Diseases Society of America] has been a bit more conservative mentioning waiting until the third recurrence. And this is based on the fact that these guidelines were given when there was no FDA-approved treatment. So, what are some challenges with the traditional FMT approaches?

Andrew Skinner, MD: With the traditional FMT approaches, one of the challenges that we're up against now is that it's, they're not have been evaluated by the FDA. So the more traditional FMT have not been FDA approved. One of the other approaches that we have is that there's also a bit of a, the manufacturing processes not that well documented in terms of the screening of some of these patients. And are some of these even being done within a practitioner's own clinic? And then the other portion that we worry about is also the transmission of certain pathogens. And so that's where the patient's safety comes into play as well. There have been reports of antibiotic-resistant pathogens being transmitted into recipients of the traditional FMT.

Stuart Johnson, MD: Right. So, although screening for pathogens is critical, there are things we don't, we know that would be hepatitis B, etc. There are things we know we don't know, and that might be hepatitis in children. And then there are things we don't know. And again, it points out that we can screen for things we know, but there may be things out there we don't know. Just a word of caution about a transfer.

Transcript edited for clarity