Bharati Vidyapeeth (Deemed to be University) College of Nursing

FECAL MICROBIOTA
TRANSPLANTATION
 INTRODUCTION

The human GI tracts harbors a diverse community of micro-organisms, collectively known as gut
microbiota . Which play a crucial role in maintaining digestive health ,regulating the immune system and
maintaining numerous physiological process. Disruption in the micro balance , often due to factors such as
antibiotic use, infection or IBD can lead to dysbiosis – an imbalance of gut microbiota associated with various GI
disorders.
Fecal Microbiota Transplantation(FMT) is an innovative medical procedure gaining increasing recognition
for its potential in treating various GI disorders . This involves transfer of fecal matter from a healthy donor into GI
tract of a recipient , with a aim of restoring a healthy balance of gut microbiota
 HISTORY OF FECAL MICROBIOTA
TRANSPLANTATION(FMT)
1st use of FMT: In China , 4th century . Ge Hong used “yellow soup” to treat his patient with
severe diarrhoea.
1st use of FMT in western medicine: In 1958, Ben Eiseman and colleagues, a team of
surgeon from Colorado, treated for critically ill people with Fulminant Pseudomembranous
colitis using faecal enemas.
World's first micro biota super donor stool bank : 2017 by MICROBIOMA.ORG
Biome Bank : Australia in 2020
First stool Donation in India : Kochi by Lisie Hospital
Open Biome : large stool bank in 2018, the stool bank received 7,536 stool donations from
210 donors, a daily average of 20.6 donations, and processed 4.271 of those donations into
FMT preparations
1st successful faecal micro biota transplantation (FMT) in India : on November 14,2014 in
Delhi for a patient with Irritable bowel syndrome
 DEFINITION

Fecal transplantation is a procedure to collect feces, also called stool

or poop, from a healthy donor and introduce them into a patient’s
gastrointestinal tract.

A fecal transplant also known as the fecal micro biota transplantation

involves transferring fecal material from a healthy donor to recipient’s
GI tract to restore or promote a balanced gut micro biome.
 PURPOSES

1. To use, high-quality donor faeces solutions to treat patients with

recurrent or refractory Clostridium difficile infection.

2. To treat conditions related to the gut micro biome.

3. Restore a healthy balance of gut bacteria by introducing fecal

material from a healthy donor.
 INDICATION

• Recurrent Clostridium difficile Infection (CDI)

• Inflammatory Bowel Disease (IBD)
• Irritable Bowel Syndrome (IBS)
• Antibiotic-Associated Diarrhea
• Metabolic Disorders
• Autoimmune Disorders (with suspected links to gut micro biota)
• Neurological Disorders (like Parkinson's disease).
 CONTRAINDICATION

• Neutropenia (lack of white blood cell count )

• Immuno-Compromised Individuals (increased risk of infections or
complications).
• Certain Medical Conditions (inflammatory bowel disease (IBD) or a
history of bowel surgery).
• Presence of Infectious Agents (if the donor's fecal sample carries
potential risks of transmission).
• Unknown Long-Term Effects
• Allergies or Sensitivities (in the faecal material ).
 COLLECTION AND STORAGE OF FAECAL SAMPLE

• As the majority of fecal bacteria are anaerobic, faeces must be processed within 6
hours of defecation. If the screening is completed stool should be collected from an
individual donor within 1 month.
• Cleaning the equipment (e.g. Fecotainer)
• Donors have the option of donating on site or taking the bag home with the cooler
box and ice pack so it can be delivered within 1 hour of defecation.
• stored for up to 8 hours at 4oC without significant impact on bacterial survival
• Stool analyses include microscopic examination, chemical, immunologic, and
microbiologic tests
• Stool samples can be examined for leukocytes, occult blood, fat, sugars (reducing
substances), pH, pancreatic enzymes, alpha-1 antitrypsin, calprotectin, and infectious
causes (bacteria, viruses, and parasites)
 ROUTES FOR ADMINISTRATION

FMT can be delivered through the following routes:

Upper gastrointestinal route
1. Nasogastric/Naso jejunal tube
2. Endoscopy
3. Oral capsule
Lower gastrointestinal route
1. Sigmoidoscopy
2. Retention Enema
3. Colonoscopy
 CRITERIA FOR THE STOOL DONORS

The selection of stool donors for faecal micro biota transplantation (FMT) involves
careful screening to ensure the safety and efficacy of the procedure.
Criteria for stool donors typically include:
Good Health
Ideal anthropometric measurements
No History of Gastrointestinal Disorders
No Antibiotic Use in the Past Few Months
No High-Risk Behaviours
Screening for Specific Microbial Markers
Blood and Stool Tests
Commitment to Regular Screening
 DONOR DIET REQUIREMENT

• FMT stool donors consumed higher fibre diets than the general
population (26 vs. 18 g/day) More recently a focus on donors
following specific dietary patterns such as veganism and
Mediterranean diets has emerged. For example, a trial of FMT
participants met the recommendations for micronutrients and food
groups except calcium, fruit, and dairy/dairy alternatives.
 FOOD TO INCLUDE(High fibre diet)
• All breads, cereals and grains should be wholemeal. This includes bread, pasta, rice and
breakfast cereals.
• Eat plenty of fresh vegetables (with the exception of corn).
• Include beans and pulses in your diet (lentils, chickpeas, beans, hommos)
• Eat at least two pieces of fruit per day
• Drink at least 1 litre of water per day.
• Donors will be recommended to commence supplements that are believed to be beneficial in
producing an environment conducive for the continued growth of good bacteria in the bowel.
These supplements include:
• Apple pectin
• Inulin – N.B. It is recommended that you start supplementation at the lowest therapeutic dose
specified by the manufacturer.
• N-acetylglucosamine (N-A-G).
 FOOD TO AVOID

• High Risk’ Foods, Which Are More Susceptible To Growing Bad

Bacteria
• Avoid shellfish, prawns, oysters, raw fish and processed meats such as
salami, ham and sausages.
• Avoid all antibiotics
PROCESS OF PREPARATION AND STORAGE OF THE
FAECES SAMPLE
• Approximately 60 g of donor faeces is used based on the data of a systematic
review suggesting a decrease cure rate with <50 g .
• Homogenised with saline [NaCl](using a mortar and pestle ).
• metal sieve (mesh 300 nm) is used to remove undigested (Fibre)food
fragments.
• concentrated by centrifugation.
• Half of the original volume of faecal suspension is added to N-
Bromosuccinimide
• Glycerol is added as cryoprotectent
• Stored at -80o C until 5 to 6 months, but could be much longer, Like Open
Biome, The NDFB is uses a storing period of 2 years.
 ROLE OF NURSE IN THE FAECAL BANKING.

• Patient Education
• Informed Consent(explaining the purpose, risks, and potential benefits of the
procedure)
• Sample Collection Assistance(maintain the integrity of the samples)
• Documentation and Record-Keeping(comprehensive records for patient care and
research purposes)
• Patient Monitoring(ensuring the well-being of individuals involved in the faecal banking
process)
• Adherence to Protocols(ensuring the safety of both donors and recipients)
• Communication with Healthcare Team(to facilitate smooth coordination of the faecal
banking process)
• Post-Procedure Care(ensuring that individuals are comfortable and informed).
 IMPORTANCE OF KNOWLEDGE REGARDING
FAECAL BANKING.
• Treatment Advancements(success in treating recurrent Clostridium difficile infections)
• Innovations in Gastroenterology(in gastroenterology)
• Prevention and Management of Diseases(by targeting the gut microbiota)
• Treatment of Gastrointestinal Conditions(treating recurrent Clostridium difficile
infections)
• Patient Education
• Informed Decision-Making(Healthcare professionals, need to be knowledgeable about
the procedure to help patients make informed decisions)
• Infection Control(Proper handling and processing of fecal samples)
• Emerging Therapies(, allows healthcare professionals to adapt their knowledge and
practices )
SUCCESS RATES AFTER THE FAECAL MICRO BIOTA
TRANSPLANTATION
Cure rates after faecal micro biota transplantation (FMT) can vary depending on the specific condition being
treated.
Clostridium difficile Infection (CDI):
FMT has shown high cure rates for recurrent CDI, with success rates often exceeding 90%. FMT is
considered a highly effective treatment for this specific condition.
Inflammatory Bowel Disease (IBD):
The evidence for the effectiveness of FMT in treating IBD, including conditions like Crohn’s disease and
ulcerative colitis, is still evolving. Some studies suggest positive outcomes, while others show more varied
results.
Irritable Bowel Syndrome (IBS):
The efficacy of FMT in treating IBS is not as well-established, and research is ongoing. Results have been
mixed, and more studies are needed to determine its effectiveness for IBS.
Metabolic Conditions:
FMT is being explored for its potential impact on metabolic conditions like obesity and metabolic
syndrome. However, its effectiveness for these conditions