title: Fecal microbiota transplantation for Clostridium difficile infection: back to the future.
abstract: BACKGROUND
  Clostridium difficile infection (CDI) is a leading cause of diarrhea in the industrialized world. The estimated costs of this infection are impressive: over 3.2 billion dollars annually in the US. The introduction of fecal microbiota transplantation (FMT) to clinical practice can be considered a Copernican Revolution. The rationale of this approach consists of correcting the imbalance of the organisms dwelling in the gut by reintroducing a normal flora.
  
  
  METHODS
  This review focuses on the indication for FMT in CDI; it examines in-depth the most relevant aspects of the techniques used, and the safety and efficacy of this new 'old' therapy.
  
  
  CONCLUSIONS
  Authoritative guidelines about the management of CDI strongly recommend FMT for multiple recurrent episodes of infection by C. difficile unresponsive to repeated antibiotic treatment. The cure rates are about 90%, with no serious adverse events having been reported. The main concerns are the long-term outcomes, lack of a standardized procedure for the delivery of donor material, and a cultural barrier to the transplantation of fecal microbiota. A promising solution to some of these problems could be the use of a more acceptable administration route of fecal material, namely, oral capsules.
authors.affiliation: University of Naples "Federico II", Department of Clinical Medicine and Surgery, Section of Infectious Diseases, Naples , Italy +39(0)81 7463178 ; +39(0)81 7463190 ; ivan.gentile@unina.it.
authors.forename: Guglielmo
authors.initials: G
authors.lastname: Borgia
authors.forename: Alberto Enrico
authors.initials: AE
authors.lastname: Maraolo
authors.forename: Maria
authors.initials: M
authors.lastname: Foggia
authors.forename: Antonio Riccardo
authors.initials: AR
authors.lastname: Buonomo
authors.forename: Ivan
authors.initials: I
authors.lastname: Gentile
mesh_terms: D002986:Clinical Trials as Topic; D016360:Clostridioides difficile / Q000302:isolation & purification / Q000502:physiology; D003015:Clostridium Infections / Q000382:microbiology / Q000503:physiopathology / Q000628:therapy*; D055317:Evidence-Based Practice; D000069467:Fecal Microbiota Transplantation; D005243:Feces / Q000382:microbiology; D000069196:Gastrointestinal Microbiome; D006801:Humans; D012008:Recurrence
keywords: Clostridium difficile infection; antibiotics; diarrhea; dysbiosis; feces; gut; microbiota; recurrence