Challenges in fecal donor selection and screening for fecal microbiota transplantation: A review

Abstract

Fecal microbiota transplantation is best understood as an effective and inexpensive therapy for recurrent Clostridium difficile infection but fecal donor selection and screening should be periodically revised. Here, we review current recommendations for selection and screening of fecal donors for fecal microbiota transplantation. We recommend considering diabetes mellitus, prior cardiovascular events, and clinical healthcare exposure as fecal donor exclusion criteria until more is known about the association of these conditions with the human gut microbiome. We review the non-bacterial members of the human gut microbiome, associations of the gut microbiome with colorectal malignancies, the human gut resistome and how these may impact future donor screening recommendations. Collaboration between clinicians, clinical laboratory scientists, industry and regulatory agencies will be critically important for continued improvement in donor selection and screening.

Keywords: Clostridium difficile; FMT; antibiotic resistance; fecal microbiota transplantation; gut microbial therapeutics; microbiome; resistome; stool donor screening.

Figure 1.

Established influences and health conditions associated with the human gut microbiome. MDRO denotes multi-drug resistant organism.