Thursday, April 7, 2016

Fresh or Frozen, Does it Matter? Fecal Transplantation for the management of Recurrent C. difficile Infection

A major barrier to Fecal Microbiota Transplantation (FMT ) for the management of recurrentC. difficile infection is obtainment of the donor stool. 

Enter Open Biome, a non-profit organization that provides hospitals with screened, banked frozen stool for administration.

I regularly  perform FMTs at VCU Medical Center by infusing banked donor stool from OpenBiome into the duodenum via a dobhoff tube. This protocol was pioneered at our center by Dr. Micheal Edmond, now at the University of Iowa. The efficacy of FMT via duodenal infusion is supported by this important article in the New England Journal of Medicine.

This article, recently published in the Journal of the American Medical Association, suggests that banked, frozen stool is at least as effective as a fresh stool for the management of recurrent C. difficile. Banking frozen stool in the pharmacy for use on demand is a massive simplification and improvement over patient identified donor stool.  In my opinion,the procedure has become more simple than ever.

The FMT reimbursement is minuscule, but in the end, that's not what to motivates us to help others.

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