title: Standardized frozen preparation for transplantation of fecal microbiota for recurrent Clostridium difficile infection.
abstract: OBJECTIVE
  While fecal microbiota transplantation (FMT) is historically known to be an effective means to treat recurrent Clostridium difficile infection (CDI) refractory to standard antibiotic therapies, the procedure is rarely performed. At least some of the reasons for limited availability are those of practicality, including aesthetic concerns and costs of donor screening. The objective of this study was to overcome these barriers in our clinical FMT program.
  
  
  METHODS
  We report clinical experience with 43 consecutive patients who were treated with FMT for recurrent CDI since inception of this program at the University of Minnesota. During this time, we simplified donor identification and screening by moving from patient-identified individual donors to standard volunteer donors. Material preparation shifted from the endoscopy suite to a standardized process in the laboratory, and ultimately to banking frozen processed fecal material that is ready to use when needed.
  
  
  RESULTS
  Standardization of material preparation significantly simplified the practical aspects of FMT without loss of apparent efficacy in clearing recurrent CDI. Approximately 30% of the patients had underlying inflammatory bowel disease, and FMT was equally effective in this group.
  
  
  CONCLUSIONS
  Several key steps in the standardization of donor material preparation significantly simplified the clinical practice of FMT for recurrent CDI in patients failing antibiotic therapy.
authors.affiliation: Department of Soil, Water, and Climate, BioTechnology Institute, and Microbial and Plant Genomics Institute, University of Minnesota, St. Paul, Minnesota, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Hamilton
authors.forename: Alexa R
authors.initials: AR
authors.lastname: Weingarden
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Sadowsky
authors.forename: Alexander
authors.initials: A
authors.lastname: Khoruts
mesh_terms: D016360:Clostridioides difficile; D003106:Colon / Q000382:microbiology*; D004761:Enterocolitis, Pseudomembranous / Q000150:complications / Q000628:therapy*; D005243:Feces / Q000382:microbiology*; D005260:Female; D005615:Freezing; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D014019:Tissue Donors