Fecal microbiota transplantation: Literature review

Abstract

Objective: Despite the advancement of antimicrobial treatments, Clostridium difficile infection (CDI) remains the most commoncause of nosocomial infectious diarrhea in adults, and is increasing in frequency and severity in the United States. The reducedefficacy of antimicrobial treatment therapies is a real concern among practitioners and has fuelled the search for alternativetreatment options. Fecal Microbiota Transplantation (FMT) has been reported as a safe and effective treatment for CDI for more than 50 years, but has failed to make its way into common practice. The aim is to assess current literature pertaining to the efficacyof FMT as a treatment option for CDI using the Stetler model.

Method: An electronic search using CINHAL Complete, MEDLINE, and Cochrane databases, limited only to articles from academic journals that had full text access and that were published within the last five years. Selection criteria were systematic reviews, and original research studies that used FMT, regardless of delivery modality, for the treatment of recurring and/orrefractory CDI (rCDI) and that had laboratory confirmed results and that reported follow-up.

Conclusion: While there is an abundance of literature reporting FMT as a safe and durable practice, most of the publishedliterature consists of case studies and retrospective reviews. The analysis of the selected articles suggests FMT has a substantial effect for the treatment of recurrent CDI. Only three RCTs appear to have been published and majority of the systematic reviews predate the RCTs. More controlled studies with adequate sample sizes are needed before establishing FMT as best practice.