Could Fecal Microbiota Transplantation Cure All Clostridium Difficile Infections?

Abstract

1 ISSN 1746-0913 10.2217/FMB.13.146 © 2014 Future Medicine Ltd Future Microbiol. (2014) 9(1), 1–3 In its current form, fecal microbiota transplantation (FMT) is a novel medical therapy. Intriguingly, however, early Chi­ nese writings reveal that it was practiced centuries ago in its crudest form using ingested fecal material to treat gastro­ intestinal ailments such as food poisoning and severe diarrhea [1]. As we discuss here, this ancient medical practice may now be coming ‘full circle’. In 1958, Eiseman and colleagues documented the first modern report of FMT to treat pseudomembranous colitis due to suspected Clostridium difficile infection (CDI). The authors detailed an “immediate and dramatic response” following FMT and suggested that “this simple yet rational therapy method should be given more extensive clinical evalu­ ation” [2]. Although C. difficile was not described until 1978, the Eiseman et al. report and several others that followed [3,4] almost certainly described treatments for what we now know to be CDI colitis. Subsequently, recognizing the powerful therapeutic potential of normal gastroin­ testinal microbiota, Borody et al. reported on a case series of 55 patients treated with FMT at the Centre for Digestive Diseases (New South Wales, Australia) expanding into the areas of idiopathic colitis, irritable bowel syndrome and Crohn’s disease in addition to CDI cases [5]. At the time, CDI had not yet become a major clinical issue and went largely ‘under the radar’ until the emergence of epidemic strains in 2000 [6]. Since then, CDI incidence has increased exponentially, with higher morbidity and mortality than seen in previous years. Here, we examine the expanding role of FMT in the various presentations of CDI.