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The use of faecal microbiota transplant as treatment for recurrent or refractory Clostridium difficile infection and other potential indications: joint British Society of Gastroenterology (BSG) and Healthcare Infection Society (HIS) guidelines
  1. Benjamin H Mullish1,2,
  2. Mohammed Nabil Quraishi3,
  3. Jonathan P Segal1,4,
  4. Victoria L McCune5,6,
  5. Melissa Baxter7,
  6. Gemma L Marsden8,
  7. David J Moore9,
  8. Alaric Colville7,
  9. Neeraj Bhala3,9,10,
  10. Tariq H Iqbal3,10,
  11. Christopher Settle11,
  12. Graziella Kontkowski12,
  13. Ailsa L Hart1,4,
  14. Peter M Hawkey6,
  15. Simon D Goldenberg13,14,
  16. Horace R T Williams1,2
  1. 1 Division of Integrative Systems Medicine and Digestive Disease, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
  2. 2 Departments of Gastroenterology and Hepatology, St Mary’s Hospital, Imperial College Healthcare NHS Trust, London, UK
  3. 3 Department of Gastroenterology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  4. 4 Inflammatory Bowel Disease Unit, St Mark’s Hospital, London, UK
  5. 5 Public Health England, Public Health Laboratory Birmingham, Birmingham, UK
  6. 6 Institute of Microbiology and Infection, University of Birmingham, Birmingham, UK
  7. 7 Department of Microbiology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
  8. 8 Healthcare Infection Society, London, UK
  9. 9 Institute of Applied Health Research, University of Birmingham, Birmingham, UK
  10. 10 Institute of Translational Medicine, University of Birmingham, Birmingham, UK
  11. 11 Department of Microbiology, City Hospitals Sunderland NHS Foundation Trust, Sunderland, Sunderland, UK
  12. 12 C diff Support, London, UK
  13. 13 Centre for Clinical Infection and Diagnostics Research, King’s College London, London, UK
  14. 14 Department of Microbiology, Guy’s and St Thomas' NHS Foundation Trust, London, UK
  1. Correspondence to Dr Horace R T Williams, Department of Gastroenterology, St Mary’s Hospital, Imperial College Healthcare NHS Trust, London, W2 1NY, UK; h.williams{at}imperial.ac.uk

Abstract

Interest in the therapeutic potential of faecal microbiota transplant (FMT) has been increasing globally in recent years, particularly as a result of randomised studies in which it has been used as an intervention. The main focus of these studies has been the treatment of recurrent or refractory Clostridium difficile infection (CDI), but there is also an emerging evidence base regarding potential applications in non-CDI settings. The key clinical stakeholders for the provision and governance of FMT services in the UK have tended to be in two major specialty areas: gastroenterology and microbiology/infectious diseases. While the National Institute for Health and Care Excellence (NICE) guidance (2014) for use of FMT for recurrent or refractory CDI has become accepted in the UK, clear evidence-based UK guidelines for FMT have been lacking. This resulted in discussions between the British Society of Gastroenterology (BSG) and Healthcare Infection Society (HIS), and a joint BSG/HIS FMT working group was established. This guideline document is the culmination of that joint dialogue.

  • enteric bacterial microflora
  • intestinal microbiology
  • colonic microflora
  • infective colitis
  • inflammatory bowel disease

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Footnotes

  • BHM, MNQ and JPS are joint first authors.

  • 32 SDG and HRTW are joint senior authors.

  • Contributors BHM, MNQ and JS performed the literature extraction, using a protocol developed with DJM and approved by all members of the working group. The authors worked collectively as a working group in evaluating evidence, deciding recommendations and writing the manuscript.

  • Funding There was no external funding for this work. BHM is the recipient of a Medical Research Council Clinical Research Training Fellowship (grant reference: MR/R000875/1). BHM and HRTW receive support from the National Institute for Health Research (NIHR) Imperial Biomedical Research Centre (BRC) based at Imperial College Healthcare NHS Trust and Imperial College London.

  • Competing interests THI acted as a consultant, advisor or speaker for Pharmacosmos and Shield Therapeutics. ALH acted as a consultant, advisory board member or speaker for AbbVie, Atlantic, Bristol-Myers Squibb, Celltrion, Falk, Ferring, Janssen, MSD, Napp Pharmaceuticals, Pfizer, Pharmacosmos, Shire and Takeda. ALH also serves on the Global Steering Committee for Genentech. SDG received consultancy fees, speaker fees and research grant support from Astellas between 2015 and 2017; received consultancy fees and speaker fees from MSD between 2015 and 2017; and received consultancy fees in 2017 from Pfizer.

  • Patient consent Not required.

  • Provenance and peer review Commissioned. Peer review through stakeholder consultation, HIS (SDC and Council), BSG (CSSC and Council) and externally.

  • Data sharing statement All data from this work are provided in the manuscript and supplementary files.

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