The transplantation of faecal microbiota from a healthy donor has been shown in recent clinical studies to be a safe and highly effective treatment for recurrent Clostridium difficile (C. difficile) infection and is now recommended in European treatment guidelines. Faecal microbiota transplantation (FMT) has emerged as a revolutionary, potentially life-saving treatment for this common, difficult-to-treat infection, and is showing promise in the management of other microbiota-related conditions.
Presenting at the 22nd United European Gastroenterology Week (UEG Week 2014) in Vienna, Austria, Professor Antonio Gasbarrini from the Gemeli University Hospital in Rome believes that FMT should now be used more widely in order to reduce both the clinical and economic burden of microbiota-related disease. "FMT is an old procedure that has gained in popularity in recent years," he says. "When used in patients with recurrent C. difficile infections, which are extremely difficult to treat, FMT eradicates the bacteria in around 90% of cases with a good safety profile."
The challenges of C. difficile infection
C. difficile infection is the most common cause of hospital-acquired diarrhoea, and is associated with significant morbidity and mortality in hospitalized patients. Infection rates have been rising rapidly in Europe and reports of emerging new strains, growing antibiotic resistance, and increased susceptibility in non-hospitalized individuals are of grave concern. C. difficile infection causes severe diarrhoea, intestinal inflammation and toxin-mediated cell death that, in severe cases, can lead to shock, hypotension, ileus or megacolon. Standard first-line therapies include the antibiotics, vancomycin or metronidazole, which are initially effective in most individuals. Unfortunately, approximately 20% of successfully-treated patients will have an infection recurrence, and many of these will experience multiple recurrences.
"Recurrent C. difficile infections are particularly difficult to treat, with long courses of antibiotics further disrupting the normal gut microflora, putting the patient at great risk of serious complications such as sepsis or perforation of the bowel," says Prof. Gasbarrini. "There is an urgent need for more effective treatments for recurrent C. difficile infections and FMT is definitely one of them."
FMT for C. difficile infection
FMT is an innovative treatment that was first described in C. difficile infection in the 1950s, and is being used increasingly in everyday practice. In FMT, healthy microbiota harvested from a donated stool sample is transplanted into the intestine of the recipient - often by colonoscopy or enema - where it helps to restore the normal composition of the gut flora and overcome the toxic consequences of C. difficile infection.
Studies in patients with C. difficile infection have confirmed that the treatment has a good safety record and is highly effective - quickly eradicating recurrent infections in around 90% of patients. While once considered a last-resort option for only the brave or desperate, FMT is now officially recommended in influential European treatment guidelines for recurrent C. difficile infections.
"FMT can be considered a very simple form of organ transplantation that does not require immunological matching of donor and recipient and does not need immunosuppression after the procedure," says Prof. Gasbarrini. "I am delighted that FMT has now been formally recognised as an effective treatment for recurrent C. difficile infection and I hope the technique will now be used more widely in an effort to relieve some of the burden of this troublesome infection."