Fecal microbiota transplantation for Clostridium difficile infection: A surgeon׳s perspective

The human gastrointestinal microbiota is composed of a diverse and complex array of bacteria, fungi, and viruses that reside within our gastrointestinal (GI) tract. The microbiota plays a vital role in metabolism, vitamin production, and perhaps most importantly, protection from invasion by pathogenic microorganisms. The modern era of antibiotic use has resulted in unanticipated damage to the microbiota and the disruption of the delicate balance between the microorganisms of which it is composed. Over the last 15 years, there has been an alarming rise in the incidence and severity of Clostridium difficile infection (CDI), with accompanying increases in morbidity and significant mortality. Driven at least in part by the CDI epidemic, fecal microbiota transplantation (FMT) has emerged as an astonishingly effective cure of CDI and has gained widespread acceptance as the treatment of choice for recurrent or relapsing CDI (R-CDI) as well as severe CDI. With the increased practice of FMT in many hospitals, it is pertinent to discuss, from the surgeon׳s perspective, the use of FMT in the various clinical scenarios encountered on the surgical service.