Clinics in Colon and Rectal Surgery 2020; 33(02): 092-097
DOI: 10.1055/s-0040-1701233
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Fecal Microbiota Transplantation: Redefining Surgical Management of Refractory Clostridium difficile Infection

Yao-Wen Cheng
1  Department of Gastroenterology, University of California San Francisco, San Francisco, California
Monika Fischer
2  Division of Gastroenterology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
› Author Affiliations
Further Information

Publication History

Publication Date:
25 February 2020 (online)


Fecal microbiota transplantation (FMT) is the process of transplanting stool from a healthy donor into the gut of a diseased individual for therapeutic purposes. It has a clearly defined role in the treatment of recurrent Clostridium difficile (reclassified as “Clostridioides difficile”) infection (CDI), with cure rates over 90% and decreased rates of subsequent recurrence compared with anti-CDI antibiotics. There is emerging evidence that FMT is also effective in the treatment of severe and fulminant CDI, with associated decreases in mortality and colectomy rates compared with standard antibiotic therapy. FMT shows promise as salvage therapy for critically-ill CDI patients refractory to maximum medical therapy and not deemed to be surgical candidates. FMT should be considered early in the course of severe CDI and should be delivered immediately in patients with signs of refractory CDI. Expansion of FMT's use along the spectrum of CDI severity has potential to decrease associated rates of mortality and colectomy.