Faecal microbiota transplantation for recurrent C. difficile infections: challenges and improvement opportunities for clinical practice and healthcare systems

Abstract

Summary Background There is growing interest in faecal microbiota transplantation (FMT) as a treatment for recurrent Clostridioides difficile infection (CDI), but evidence on the diverse requirements for safe, effective and accessible services is fragmented and limited. Aims To identify key components of FMT provision relating to the patient care pathway, stool donor pathway and wider healthcare system, and to explore variation in practice Methods We conducted a narrative review of the literature and consultations with key clinical experts in the field. Evidence is drawn from high‐income country contexts, with an emphasis on Australia, Canada, Italy and the United Kingdom as case example countries. Results We identify and discuss key challenges to do with healthcare capacity (workforce, FMT and stool banking facilities), donors and donations, patient access and choice of FMT delivery routes, regulation, costs and reimbursement. We also identify improvement opportunities to increase awareness of FMT and referral processes, physician training, maintaining patient registries and outcome monitoring metrics, in‐country regulatory harmonisation and tackling reimbursement challenges and discuss future research needs. Conclusion Effectively bringing FMT to patients in a healthcare system requires much more than just the existence of a clinically effective procedure. With FMT being a potentially effective treatment option for recurrent CDI for many patients, a well‐rounded understanding of how appropriate FMT capacity can be built and nurtured is important for both healthcare providers and policymakers seeking to improve patient care.

Treatment of preterm brain injury via gut‐microbiota–metabolite–brain axis

“…FMT helps re‐establish the balance of GM, repair the intestinal mucosal barrier, control inflammatory responses, and regulate host immunity 135 (Figure 5 ). Numerous studies have confirmed the effectiveness and safety of FMT for treating recurrent Clostridium difficile infections, 136 IBDs, 137 and other gastrointestinal diseases. FMT can modulate neurological disorders driven by dysbiosis, and it may enhance neural regeneration in mice with spinal cord injury by restraining blood‐spinal cord barrier damage, upregulating neurotrophic factors, alleviating spinal cord ischemia, and promoting neuronal survival 138 , 139 (Table 2 ).…”

Editorial: faecal microbiota transplantation for recurrent C. difficile infections—getting the support that is needed

“…This article is linked to Hocking et al paper. To view this article, visit https://doi.org/10.1111/apt.17309 Ayushi Chauhan 1 Mayur Garg 1,2…”

“…We read with interest the paper by Hocking et al 1 regarding the numerous challenges of faecal microbiota transplantation (FMT) provision for patients with Clostridioides difficile ( C. difficile ) infection. We congratulate them for a comprehensive synthesis using a variety of literature searches and interviews with selected clinical experts from four high‐income countries.…”

Understanding the gut microbiota in cancer cachexia

“…Fecal microbiota transplantation (FMT) is a cutting-edge therapy for treating diseases related to gut dysbiosis, whereby a fecal sample from the patient before treatment (autologous) or from a healthy donor (allogeneic) is transferred to a recipient with a disease condition. Although most of the available evidence has focused on FMT as a treatment for recurrent Clostridioides difficile infection [49], recent studies have begun to investigate its potential as a promising therapeutic strategy for cancer cachexia.…”