Self-stool banking as a source for fecal microbiota transplantation: A pilot study

Abstract

Background: Fecal microbiota transplantation is a promising therapeutic alternative for refractory Clostridium difficile infection. Self-stool donation can overcome challenges with donor screening and eliminate risks of blood borne pathogen exposure. We assessed the feasibility of a fecal banking protocol. A secondary objective was to identify perceptions around fecal banking. Methods: Admitted medicine patients were screened over 15 months. Patients with gastrointestinal comorbidities or factors affecting intestinal microbiota were excluded. Participants completed a survey and could opt to bank a sample. Processing occurred during defined lab hours. Feasibility was assessed on process and resource indicators. Success was defined as 50% consent rate. Results: A total of 4,675 patients were screened; 60% were excluded, primarily because of antibiotic exposure (1,343, 48%). A total of 537 patients were surveyed, of whom 73% consented to fecal banking. The primary reason for declining was that fecal banking was considered ‘too gross’ (34%). Of 72 samples provided, 27 were successfully banked. Lack of a bowel movement was the primary reason for not banking (54%), and inadequate quantity was the top reason for rejecting a collected sample (63%). Average processing time was 58 minutes (range 22–640 min). The majority of participants reported a preference for using their own stool (82%), and 87.5% (n=64) were willing to bank again. Conclusion: A self-donor fecal banking protocol is feasible. Scalability of this process is addressed through dedicated resources for collecting and processing samples from larger cohorts. Formal evaluation of the efficacy and microbiome integrity of samples is required.