The Ethics of Fecal Microbiota Transplant as a Tool for Antimicrobial Stewardship Programs

Abstract

Multidrug resistant organisms (MDROs) are a public health threat that have reduced the effectiveness of many available antibiotics. Antimicrobial stewardship programs (ASPs) have been tasked with reducing antibiotic use and therefore the emergence of MDROs. While fecal microbiota transplant (FMT) has been proposed as therapy to reduce patient colonization of MDROs, this will require additional evidence to support an expansion of the current clinical indication for FMT. This article discusses the evidence and ethics of the expanded utilization of FMT by ASPs for reasons other than severe recurrent or refractory Clostridioides (formerly Clostridium) difficile infection.

Introduction: The Promise and Challenges of Microbiome-Based Therapies

“…Thomas Murray and Jennifer Herbst ("The Ethics of Fecal Microbiota Transplant as a Tool for Antimicrobial Stewardship Programs") bring to light a wholly different potential benefit of FMT, that of a partial solution to the emergence and growth of multi-drug resistant organisms (MDROs). 22 The standard firstline treatment for CDI is antibiotics (often vancomy-cin). However, some patients have multiple recurrences of CDI requiring more and longer courses of antibiotics.…”