Fecal Microbiota Transplantation for Clostridium Difficile Infections

For people with a severe or recurrent infection with Clostridium difficile that doesn’t respond to antibiotic treatment, NYU Langone specialists may recommend a fecal microbiota transplant. This procedure involves transferring healthy human feces to the colon of a person infected with C. difficile to reestablish the beneficial strains of bacteria that keep the “bad” ones in check.

Stool can come from a family member, friend, or a stool bank—similar to a blood bank—but the donor must be healthy. Before the procedure, the stool is rigorously tested for any communicable diseases, such as hepatitis, autoimmune disorders like celiac disease, parasites, and “bad” bacteria. Doctors must also ensure that a donor hasn’t taken antibiotics recently.

Fecal microbiota transplantation takes place during a colonoscopy, a procedure that enables a doctor to examine the colon using a long, flexible tube with a camera and light on the end. The stool sample is placed in the tube, or colonoscope, and the tip of the device is inserted into the anus. It is slowly advanced into the colon. Once it reaches the end of the colon, near the small intestines, the doctor releases the stool sample.

The procedure takes around 30 minutes. You are given a sedative to minimize discomfort.

Fecal microbiota transplantation is a treatment of last resort. Not everyone is a good candidate for the procedure. It’s especially risky in people who are taking medications that suppress the immune system, such as those who have recently had an organ or bone marrow transplant or have cirrhosis of the liver.

Doctors may recommend the procedure for those who’ve had at least three episodes of mild-to-moderate C. difficile infection that have not responded to six to eight weeks of antibiotic treatment. Mild-to-moderate symptoms include mild abdominal cramping and watery diarrhea three or more times daily.

People who have had at least two bouts of severe C. difficile infection that required hospitalization may also be eligible for a fecal transplant. Severe symptoms include weight loss, fever, watery diarrhea throughout the day and night, painful abdominal cramping and pain, and blood or pus in the stool.

The procedure may also be an option for those who have had a severe C. difficile infection or severe C. difficile–related colitis—inflammation of the lining of the colon—that did not respond to antibiotics.

Doctors monitor people who have had a fecal microbiota transplant for an hour or two after the procedure—the time it takes for the sedative wear off.

People given sedatives before or during a colonoscopy cannot drive themselves home, even if they feel alert. Most people have a family member or friend accompany them to the procedure. Once your doctor clears you to go home, you can return to your usual activities.

After a fecal transplant, the infection often resolves within a few hours to a few days.