What is fecal microbial transplantation?

Fecal microbial transplantation (FMT), also known as stool transplantation or bacteriotherapy, is a procedure in which fecal matter, or stool, is collected from a healthy donor and placed into the gastrointestinal tract of a patient. It has been demonstrated to be a safe therapy to successfully treat severe, refractory or recurrent Clostridium difficile (C. difficile) infection. C. difficile infection can occur as a complication of antibiotic therapy but it can also occur in individuals who have chronic illnesses or gastrointestinal conditions such as inflammatory bowel disease. The most common symptoms associated with C. difficile infection are diarrhea (sometimes with blood) and abdominal cramping.

Who is eligible for FMT?

If your child is diagnosed with C. difficile infection, the most common initial therapy is treatment with an antibiotic such as metronidazole or vancomycin that specifically targets the organism. About 30 percent of people treated with an antibiotic against C. difficile, may have a recurrence of infection within days or weeks after finishing the antibiotic course. If that is the case, doctors may recommend treating with a different antibiotic or with an antibiotic for longer periods of time. If the C. difficile infection recurs, your child may be eligible for FMT.

At this time, FMT is not clinically performed for indications other than recurrent C. difficile infection. More research studies are still needed to determine if FMT should be performed for other clinical indications.

How is donor stool obtained for FMT?

1. The family can identify a donor to provide the stool. This individual needs to be at least 18 years of age, undergo an examination by his/her physician, and submit to blood and stool tests. The potential donor will also need to complete a lengthy questionnaire, similar to questionnaires given when donating blood.
2. Stool can be obtained from a donor stool bank. In this situation, the bank provides stool from a healthy, unrelated donor. We use a stool bank called OpenBiome. 

How is FMT performed at Johns Hopkins Children's Center? 

We perform FMT using colonoscopy. The stool product is typically placed in the cecum (the part of the colon that is farthest away from the anus). Your child will need to do a bowel cleanout the day prior to their procedure. Instructions about when to stop eating or drinking will be given to you once your child’s procedure time is scheduled.

After the colonoscopy with FMT, your child will stay in the recovery area for at least two hours and will receive two doses of loperamide (Imodium®), an anti-diarrheal medication, which helps keep the transplant in their bowel. It is common to experience leaking after FMT since the stool product is 100 percent liquid. It is also common to have crampy, abdominal pain since we cannot suction air out during the colonoscopy once the stool is transplanted. Most children tolerate FMT very well.

Are there ongoing FMT studies at Johns Hopkins? 

Yes. Researchers at Johns Hopkins are studying FMT in children so that we can learn about what happens to the bacteria in the intestines after a child receives an FMT. The information that we learn can be applied to C. difficile infection and other intestinal conditions. You may be asked if you would like your child to join a research study if he or she comes to Johns Hopkins for FMT evaluation.