Fecal Microbiota Transplantation in Patients With Cancer
Fecal Microbiota Transplantation in Patients With Cancer
CDI is defined as the clinical presentation of watery diarrhea that may be accompanied by abdominal pain, fever, and dehydration, and is identified by a stool sample that tests positive for C. toxin (Alonso & Kamboj, 2014). The infection is often associated with antimicrobial therapy that results in an alteration of the intestinal flora. However, in patients with cancer who are treated with chemotherapy, these same symptoms may be present, even without previous antibiotic use.
Transmission of CDI in the nosocomial setting occurs primarily through environmental contamination or through the improper hand hygiene of healthcare workers. Spread of the organism occurs by the fecal-oral route. Risk factors for the development of CDI include advanced age, prolonged hospitalizations, and antimicrobial therapy. In the cancer setting, chemotherapeutic agents, along with resultant neutropenia and immunosuppression, increase the risk and clinical severity of CDI (Khan et al., 2012). Gut flora is altered by the antineoplastic agents used in treating patients with cancer, predisposing these patients to CDI. Specific cancer treatments associated with CDI include methotrexate, 5-fluorouracil, irinotecan, topotecan, cisplatin, paclitaxel, and carboplatin (Khan et al., 2012).
A promising approach to recurrent CDI is FMT, which involves the introduction of fecal microbiota from a healthy donor into the gastrointestinal tract of a patient with a diseased colon to restore normal gut microbiota. Some conditions in which FMT has shown efficacy include inflammatory bowel disease, insulin resistance in type 2 diabetes, and recurrent CDI (Borody & Campbell, 2012; Smits, Bouter, de Vos, Borody, & Nieuwdorp, 2013; van Nood et al., 2013). Success rates for FMT for recurrent CDI range from 81%–92% (Brandt et al., 2012; Cammarota, Ianiro, & Gasbarrini, 2014; Gough, Shaikh, & Manges, 2011; Guo, Harstall, Louie, Veldhuyzen van Zanten, & Dieleman, 2012; Kassam, Lee, Yuan, & Hunt, 2013; Lee et al., 2014; Sofi et al., 2013; van Nood et al., 2013).
Based on literature showing the success of FMT in the treatment of CDI, the U.S. Food and Drug Administration (FDA) allows its use as long as healthcare providers obtain informed consent from patients, as well as inform them about the procedure's investigational nature and its associated risks (U.S. Department of Health and Human Services, FDA, & Center for Biologics Evaluation and Research, 2013).
Literature Review
CDI is defined as the clinical presentation of watery diarrhea that may be accompanied by abdominal pain, fever, and dehydration, and is identified by a stool sample that tests positive for C. toxin (Alonso & Kamboj, 2014). The infection is often associated with antimicrobial therapy that results in an alteration of the intestinal flora. However, in patients with cancer who are treated with chemotherapy, these same symptoms may be present, even without previous antibiotic use.
Transmission of CDI in the nosocomial setting occurs primarily through environmental contamination or through the improper hand hygiene of healthcare workers. Spread of the organism occurs by the fecal-oral route. Risk factors for the development of CDI include advanced age, prolonged hospitalizations, and antimicrobial therapy. In the cancer setting, chemotherapeutic agents, along with resultant neutropenia and immunosuppression, increase the risk and clinical severity of CDI (Khan et al., 2012). Gut flora is altered by the antineoplastic agents used in treating patients with cancer, predisposing these patients to CDI. Specific cancer treatments associated with CDI include methotrexate, 5-fluorouracil, irinotecan, topotecan, cisplatin, paclitaxel, and carboplatin (Khan et al., 2012).
A promising approach to recurrent CDI is FMT, which involves the introduction of fecal microbiota from a healthy donor into the gastrointestinal tract of a patient with a diseased colon to restore normal gut microbiota. Some conditions in which FMT has shown efficacy include inflammatory bowel disease, insulin resistance in type 2 diabetes, and recurrent CDI (Borody & Campbell, 2012; Smits, Bouter, de Vos, Borody, & Nieuwdorp, 2013; van Nood et al., 2013). Success rates for FMT for recurrent CDI range from 81%–92% (Brandt et al., 2012; Cammarota, Ianiro, & Gasbarrini, 2014; Gough, Shaikh, & Manges, 2011; Guo, Harstall, Louie, Veldhuyzen van Zanten, & Dieleman, 2012; Kassam, Lee, Yuan, & Hunt, 2013; Lee et al., 2014; Sofi et al., 2013; van Nood et al., 2013).
Based on literature showing the success of FMT in the treatment of CDI, the U.S. Food and Drug Administration (FDA) allows its use as long as healthcare providers obtain informed consent from patients, as well as inform them about the procedure's investigational nature and its associated risks (U.S. Department of Health and Human Services, FDA, & Center for Biologics Evaluation and Research, 2013).