Fecal Microbiota Transplantation for the Critically Ill Patient

Abstract

The gut microbiome has been implicated in a diversity of diseases, such as irritable bowel syndrome, inflammatory bowel disease, hepatic steatosis, metabolic syndrome, obesity, and anxiety. Current research also suggests the presence of a bidirectional relationship between the composition of the gut microbiome and critical illness. In the critical care setting, multiple factors (eg, use of antibiotics, aberrant nutrition, bloodstream infections, bowel ischemia, and abnormal bowel motility) strongly contribute to intestinal dysbiosis. Conversely, early studies have associated intestinal dysbiosis with worse clinical outcomes in the intensive care unit (ICU), such as infection, organ failure, and mortality. The possibility of intestinal dysbiosis influencing these clinical outcomes has prompted the question of whether microbiome manipulation strategies, such as fecal microbiota transplantation (FMT), may have a role in the management of critical illness. After a literature search of FMT used in the ICU for indications other than Clostridium difficile infections, we found 4 case reports that describe the use of FMT in 5 critically ill patients with systemic inflammatory responses and no clear source of infection. This review discusses the relationship between the gut microbiome and critical illness, early data on the use of FMT in critical care, and safety considerations of FMT in the critically ill and immunocompromised populations.

Fecal microbiota transplantation is feasible even in critically ill patients with toxic megacolon due to Clostridium difficile infection

“…Fecal microbiota transplantation is a well-documented and recommended method of treatment in recurrent and resistant C. difficile infection [2,10]. There are no guidelines and few data regarding this treatment in critically ill ICU patients [11][12][13][14]. We encountered a few problems in the presented case.…”

Fecal microbiota transplantation reconstructs the gut microbiota of septic mice and protects the intestinal mucosal barrier

“…The gut microbiome contains 40 trillion microorganisms, a similar number of cells as found in the human host. This includes up to 1000 different microbial species and 100 times more bacterial genes than human genes 6,[10][11][12][13] . The symbiotic relationship between microbiota and the host is mutually beneficial 14 .…”

“…Recently, the use of FMT has been reported in septic patients with MODS and non-C.difficile diarrhea, presenting as refractory to standard medical management. At 2-3 weeks post-FMT, the patients showed resolution of their diarrhea and significant decreases in blood levels of inflammatory mediators, such as TNF-α, interleukin (IL)-1β, IL-6, and C-reactive protein 11,16 . Following FMT, stool microbiota in these patients showed marked alterations resembling the microbiota composition of the donors, with an increase in Firmicutes and a reduction in Proteobacteria.…”

Fecal microbiota transplantation reconstructs the gut microbiota of septic mice and protects the intestinal mucosal barrier

“…The gut microbiome contains 40 trillion microorganisms, a similar number of cells as found in the human host. This includes up to 1000 different microbial species and 100 times more bacterial genes than human genes [6,[10][11][12][13]. The symbiotic relationship between microbiota and the host is mutually bene cial [14].…”

“…Recently, the use of FMT has been reported in septic patients with MODS and non-C.di cile diarrhea, presenting as refractory to standard medical management. At 2-3 weeks post-FMT, the patients showed resolution of their diarrhea and signi cant decreases in blood levels of in ammatory mediators, such as TNF-α, interleukin (IL)-1β, IL-6, and C-reactive protein [11,16].…”