Fecal Microbiota Transplantation FAQ

As much as 10% of the population carry the bacteria with no ill effects or symptoms. However, these individuals shed the bacteria through their feces. When people who carry C. difficile do not wash their hands after using the restroom, they contaminate items they touch. When others touch a contaminated surface, they may then transfer the bacteria to their food and mouths. 

Fecal microbiota transfer (FMT) reintroduces a healthy bacterial community into the patient's colon. Stool from a screened donor is transferred via the lower GI tract (by colonoscopy, sigmoidoscopy or enema) or the upper GI tract (by prepared capsule or through a tube from the nostrils to the intestine).

Your doctor may perform stool tests, blood tests, endoscopic examination or CT scan.

If you are already taking an antibiotic, your doctor may prescribe a different one to fight C. difficile. Probiotics – living organisms like bacteria or yeasts – may help. FMT is a newer treatment option. It is a procedure in which healthy stool from a donor is transferred into the patient.

Healthy donors provide the stool samples. Patients may receive stool from a universal stool bank, such as OpenBiome, or may select a friend or family member to donate. Donors and samples are carefully screened to safeguard against transmission of viruses, parasites or bacteria. Donors are tested for diseases spread through the blood, such as hepatitis and HIV.

The specifics of FMT will vary depending upon the patient's overall health and the preferences of the physician. One important part of preparation is thoroughly cleaning your bathroom with bleach and water before FMT. C. difficile can produce spores (a dormant form of the bacteria) that can survive on bathroom and other surfaces for months. To increase the success of transplantation, patients must return home to extremely clean bathrooms.

OpenBiome is a nonprofit organization dedicated to making FMT faster and easier for patients and donors. Launched in 2012, OpenBiome provides hospitals with screened, filtered and frozen material ready for clinical use. The University of Kansas Health System partners with OpenBiome to offer FMT to a broader range of patients.

C. difficile produces toxins that injure cells and cause inflammation, resulting in symptoms like watery diarrhea – as frequent as 15 times daily – abdominal pain, nausea, loss of appetite, dehydration, fever and weight loss. Severe cases can damage organs, cause low blood pressure and even result in bowel perforation that demands lifesaving surgery.

If you have been taking antibiotics for an extended period, spend time in hospitals or nursing homes, have a weakened immune system or recently had abdominal surgery, you are at greater risk. If you develop diarrhea within days of being admitted or released from the hospital or within 2 months of taking an antibiotic, speak to your doctor.

The American Gastroenterology Association suggests FMT may be an option for people who have had:

• At least 3 episodes of mild to moderate C. difficile infection that have not responded to 6-8 weeks of antibiotic treatment
• At least 2 episodes of C. difficile infection that require hospitalization
• A moderate C. difficile infection that did not respond to vancomycin or fidaxomicin antibiotics
• Severe C. difficile infection or severe colitis that did not respond to antibiotics within 2 days

FMT may be risky for people who are taking immunosuppressant medications, have had a bone marrow transplant or have cirrhosis of the liver, advanced HIV or AIDS.

Healthy individuals will most likely not develop C. difficile. Those in a weakened condition – due to age, injury or illness – are at greater risk, especially if their condition requires antibiotic use. Antibiotics can wipe out healthy organisms that reside in the GI tract, allowing C. difficile to establish itself and grow.