Physician Access to Fecal Microbial Transplant for Recurrent Clostridium Difficile Infection Is Limited in the US


Although fecal microbial transplant is highly effective in treating recurrent C. difficile infection, a survey of infectious disease specialists shows that several barriers prevent the treatment from being available at most institutions.

According to a recent study, fecal microbial transplant (FMT) is a highly effective treatment for recurrent Clostridium difficile infection (RCDI), although access is limited among physicians in the US.

These results were presented by Johan Bakken from the Section of Infectious Diseases at St. Luke’s Hospital in Duluth, MN and colleagues on October 5, 2013 at IDWeek 2013, a joint meeting of the Infectious Diseases Society of America (IDSA), the Society for Healthcare Epidemiology of America (SHEA), the HIV Medicine Association (HIVMA), and the Pediatric Infectious Diseases Society (PIDS), in San Francisco, CA.

CDI is a leading cause of infection in US hospitals, and although antibiotics are often used to treat the infection, recurrence is common. Antibiotics are often less effective in treating RCDI cases. Previous research has suggested that FMT treatment is “80-90%” effective for these recurrent infections, according to co-author Judy Streit, MD, of the University of Iowa. However, implementation of FMT is not currently widespread among physicians for several reasons, including institution regulations and feasibility. The present study conducted an electronic survey among physicians in the Emerging Infections Network (EIN), a listserv of infectious disease practitioners, to assess their use of antibiotics, non-antibiotic treatments, and their views and experiences about FMT in the treatment of CDI.

The majority (73%) of physicians surveyed treated fewer than 25 patients with CDI over the previous six months. Preferred treatment methods for RCDI varied among the physicians and were often different from national guideline recommendations, according to Bakken. The most frequent recommendation for initial CDI treatment was metronidazole, an inexpensive, relatively effective antibiotic treatment according to Bakken. Providers tend to choose vancomycin for the first and second RCDI, and may prescribe a vancomycin taper, or a low-dose, prolonged regimen of the antibiotic. Most physicians familiar with FMT recommend the treatment after two or three relapses.

Eighty percent of physicians would consider FMT for patients with RCDI. However, only 29% of physicians surveyed had FMT available at their primary institution, with 24% indicating that plans for FMT implementation are being considered. The most frequently reported barriers toward implementing the procedure include preparation and delivery logistics of the treatment and the complicated process of screening donors to prevent disease transmission. Approximately 83% of the physicians who had FMT treatment available at their primary institution stated that the treatment success rate was over 80%.

Although the use of FMT for RCDI has increased in the recent years, many physicians who wish to use it still do not have access. According to Bakken, the 2010 guidelines for RCDI treatment mention FMT treatment briefly, but he expects future guidelines to emphasize the important role of FMT in treating CDI, particularly recurrent infections. Furthermore, the authors emphasize that the barriers preventing the widespread adoption of FMT in the institutions should be addressed to improve patient access to the treatment.

The authors had nothing to disclose.

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