Fecal Microbiota Transplantation for Recurrent C difficile Infection During the COVID-19 Pandemic: Experience and Recommendations

Sahil Khanna, Aaron Tande, David T. Rubin, Alexander Khoruts, Stacy A. Kahn, Darrell S. Pardi

Research output: Contribution to journalArticlepeer-review


Objective: To report experience with fecal microbiota transplantation (FMT) for recurrent Clostridioides difficile infection (rCDI) and provide recommendations for management of rCDI and donor testing during the COVID-19 pandemic. Methods: A retrospective study of patients with rCDI who underwent FMT from May 26, 2020, to September 30, 2020, with stool from well-screened donors with health and infectious screening and a newly implemented strategy for COVID-19 screening with every 2-week bookend testing with stool quarantine. Patients were followed up for development of rCDI and COVID-19. Results: Of the 57 patients who underwent FMT for rCDI, 29 were tested for COVID-19 via nasopharyngeal polymerase chain reaction (PCR) and 22 via serology. All results were negative, except for 1 positive serology. Donor testing every 2 weeks for COVID-19 via serology and nasopharyngeal swab PCR was negative, except for 2 donors at 1 center who were excluded. Three patients had rCDI after FMT, and 1 underwent repeat FMT. One patient developed respiratory symptoms suggestive of COVID-19 and tested negative via nasopharyngeal PCR. Eleven patients who underwent COVID-19 testing for elective procedures or hospitalizations tested negative. No SARS-CoV-2 transmission was noted. Conclusions: With appropriate donor screening, FMT can be performed safely for rCDI during the COVID-19 pandemic. Development of a validated stool assay for SARS-CoV-2 will simplify this process further.

Original languageEnglish (US)
Pages (from-to)1418-1425
Number of pages8
JournalMayo Clinic Proceedings
Issue number6
StatePublished - Jun 1 2021

Bibliographical note

Funding Information:
Potential Competing Interests: Dr Khanna has received research grants from Rebiotix, Inc (a Ferring company), consulting fees from Shire Plc, Premier Inc, Facile Therapeutics, and ProbioTech Inc, outside of the submitted work. Dr Khoruts holds patents pertaining to preparation of fecal microbiota and a research grant from Finch Therapeutics . Dr Kahn has received research support from OpenBiome , Cures Within Reach (Pilot Grant and NIH 1R24AI118629-01A1), outside of the submitted work. Dr Pardi has received research grants from Vedanta and Seres Therapeutics and consulting fees from Assembly Biosciences, Inc; Gilead Sciences, Inc; Janssen Pharmaceuticals, Inc; Otsuka America Pharmaceutical, Inc; Pfizer Inc; Merck & Co, Inc; C3J Therapeutics, Inc; Nestlé; and Salix Pharmaceuticals, outside of the submitted work. The other authors report no competing interests.

Publisher Copyright:
© 2021 Mayo Foundation for Medical Education and Research

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural


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