Majdi Osman

The 5D framework: a clinical primer for fecal microbiota transplantation to treat Clostridium difficile infection

Author Contributions: JRA: drafted the manuscript, performed critical revision, final approval of the article ZK: conceptualized and designed framework, performed critical revisions MO: designed 3 rd D section and drafted section (discussion), critical revision for intellectual content SB: Conceptualized and Drafted Figure outlining approach to diarrhea post-FMT, drafted 4 th D section (delivery modality), critical revision for intellectual content related to the microbiome MF: performed critical revision for intellectual content with focus on special populations CK: performed critical revision, final approval of the article

Scaling Safe Access to Fecal Microbiota Transplantation: Past, Present, and Future

Purpose of ReviewUniversal stool banks (USBs) have emerged as a potential model for scaling access to fecal microbiota transplantation (FMT) for Clostridium difficile infection (CDI). In this review, we outline the historical barriers constraining access to FMT, the evidence on methods and outcomes of USBs, and potential future directions for expanding access.Recent FindingsKey historical barriers to FMT access include regulatory uncertainty, operational complexity of sourcing screened donor material, and logistical challenges of delivering fresh treatment preparations. USBs have demonstrated that FMT can be delivered safely at scale by centralizing donor selection, material processing, and safety monitoring. More evidence is needed to optimize USB methods, including for donor screening, material processing, and novel delivery modalities.SummaryUSBs have catalyzed broad access to FMT in North America and Europe. Future directions include developing evidence regarding oral preparations, harmonizing guidelines, disseminating best practice protocols, establishing long-term safety profiles, and expanding access to geographic areas of unmet need

Correction to: Scaling Safe Access to Fecal Microbiota Transplantation: Past, Present, and Future

In the original version of this article, author Ryan Elliott’s name was misspelled as Ryan Eliott. The correct spelling of the name is Ryan Elliott.

Faecal microbiota transplantation for Clostridium difficile infection: a multicentre study of non-responders

Age at time of FMT (years), mean (SD) 65.9 (17.9) Sex (men) 41 (30%) Ethnic background Caucasian 107 (79%) Black or African American 11 (8%) Hispanic or Latino 6 (4%) Other 3 (2%) Not reported 8 (6%) Long term care resident 19 (14%) History of inflammatory bowel disease 17 (13%) History of irritable bowel syndrome 18 (13%) Medications at time of FMT Proton pump inhibitors 53 (39%) Immunosuppressive agents 33 (24%) Laxatives 3 (2%) Anti-motility agents 26 (19%) Horn index (of disease severity) 1 (mild) 7 (5%) 2 (moderate) 62 (46%) 3 (severe) 45 (33%) 4 (extremely severe) 7 (5%) Not reported 14 (10%) Received antibiotics prior to CDI diagnosis 81 (60%) Health care-associated CDI 34 (25%) Initial CDI diagnosis method* Toxin A or B 42 (31%) Polymerase chain reaction 89 (66%) Anaerobic culture/other 2 (2%) Not reported 12 (9%) CDI treatment prior to FMT* Vancomycin 84 (62%) Metronidazole 59 (44%) Fidaxomicin 2 (2%) CDI type* Refractory CDI 48 (37%) Recurrent CDI 101 (77%) Average number of recurrences, mean (SD) 3.0 (1.9) Inpatient admission to hospital 79 (61%) NAP-1 strain of C. difficile 9 (7%) FMT delivery modality Colonoscopy 81 (60%) Enema 10 (7%) Flexible sigmoidoscopy 2 (2%) Oesophagogastroduodenoscopy 15 (11%) Nasogastric tube 10 (7%) Nasoduodenal tube 2 (2%) Other 11 (8%) Not reported 4 (3%) Colonoscopy preparation 95 (74%) Proton pump inhibitor prior to nasogastric tube 8 (80%) Frozen FMT thaw methods Water bath 73 (56%) Room temperature 40 (30%) Time between FMT and non-response (days), mean (SD) 15.3 (12.8) Patient decontaminated toilets at home Yes 51 (38%) No 26 (19%) Not reported 58 (43%) Assessed for post-infectious irritable bowel syndrome 41 (30%)