Fecal Microbiota Transfer Reliable Indications, Donor Screening, and Modes of Application

Background: Fecal microbiota transfer (FMT) is increasingly being used in Germany, as in other countries, for the treatment of recurrent Clostridioides difficile infection (rCDI). FMT is now being performed both for research and in individual patients outside of clinical trials. No compulsory standards have been established to date for donor screening or for the method of fecal transfer. Given the potential dangers of FMT, this would seem to be urgently necessary. Methods: This review is based on pertinent literature retrieved by a selective search, including the reports of consensus conferences from Germany and abroad. Results: Because of its high efficacy, FMT is the treatment of choice for rCDI. It is largely free of adverse side effects, even in immune-deficient patients, as long as comprehensive and repeated donor screening has been carried out, with extensive clinical and microbiological testing and with the use of structured questionnaires. The ingestion of frozen, encapsulated microbiota is just as effective as other modes of delivery for the treatment of rCDI. Conclusion: Encapsulation of the fecal microbiome (FM) and storage at -20 degrees C is the method of choice, because it can be standardized with the necessary quality controls and it is readily available. Patients with rCDI should undergo FMT by orally ingesting the capsules. There are ongoing research efforts to identify the active components of the FM. It is not yet clear when the ultimate goal of recombinant production can be achieved.