Study Identifies Challenges and Improvement Opportunities Relating to Faecal Microbiota Transplantation for C difficile Infections

A comprehensive understanding of how to develop and cultivate appropriate faecal microbiota transplantation (FMT) capacity is crucial for both health care providers and policymakers striving to enhance patient care for those with Clostridioides difficile infections (CDI), according to a study published in Alimentary Pharmacology and Therapeutics.

“This paper has provided a unique perspective on the diverse requirements that need to be in place to support the safe and effective delivery of FMT,” wrote the corresponding author Lucy Hocking, RAND Europe in Cambridge, UK, and study coauthors. “It shows how effectively bringing FMT to patients in a health care system requires much more than just the existence of a clinically effective procedure.”

The findings were based on a narrative review complemented with insights from clinical experts from the UK, Italy, Australia, and Canada. The review included a systematic search strategy that prioritized papers by specific inclusion and exclusion criteria. Two searches were conducted in May 2021, including literature published between 2011 and 2021. A total of 35 publications were included in the analysis.

The three core components of FMT delivery include the patient pathway at the center, the stool donor pathway that frames the patient pathway, and diverse influences of the broader health care system. Patients who meet eligibility criteria are referred for FMT as outpatients. Referral can take days to weeks and is influenced by infection severity and referral source. Gastroenterologists or infectious disease specialists can deliver FMT, and specific delivery methods vary by country, regulations, patient factors, clinician expertise, and available infrastructure.

Patients must be monitored for several weeks after the procedure, but variation in follow-up exists between countries. These represent some of the challenges with FMT delivery.

Other challenges along the FMT pathway include those related to patient access to FMT; donor identification and recruitment; sample screening; material selection, processing, preparation, and storage; health care profession awareness of FMT; regulation and policy; cost and reimbursement; society and the public; and COVID-19.

Improvement opportunities for accessing FMT services and overall patient care include training for health care professionals to understand FMT as a treatment option, exploring more flexible and convenient ways of enabling donors, and improving billing codes for the procedure to be more accessible and integrated into the health care system.

“With FMT being an important treatment option for recurrent CDI for many patients, a well-rounded understanding of how appropriate FMT capacity can be built and nurtured is important for both health care providers and policymakers seeking to improve patient care,” wrote the research authors.

Reference

Hocking L, Ianiro G, Leong RW, et al. Faecal microbiota transplantation for recurrent C. difficile infections: challenges and improvement opportunities for clinical practice and healthcare systems. Aliment Pharmacol Ther. 2023;57(5):549-564. doi:10.1111/apt.17309