| Description: |
Background Fecal microbiota transplantation (FMT) transfers stool from healthy donors to recipients and is highly effective for preventing recurrent Clostridioides difficile infection. However, rare cases of FMT-associated infections have resulted in morbidity and even mortality. Despite the critical importance of screening, evidence-based approaches to developing donor-screening protocols remain limited. Aims This review aimed to evaluate the evidence underpinning current FMT donor screening protocols by critically appraising existing literature on pathogen transmission dynamics. Methods We conducted a comprehensive review up to November 2024. Key factors considered included the geographical distribution of pathogens, likelihood of fecal-oral transmission via FMT, and the clinical consequences of potential transmission events. A Delphi process involving 25 experts in stool banking, donor screening, and FMT preparation and administration was undertaken to establish consensus on the transmissibility of pathogens via FMT, defined as ≥ 80% agreement. Transmission was categorized as definite when supported by documented evidence (e.g., case reports or confirmed donor-to-recipient transmission), possible when fecal-oral transmission was plausible but unconfirmed, and not possible when such transmission was considered unlikely. Results We identified 58 potentially-relevant pathogens and summarized their prevalence, transmissibility, disease severity, and likelihood of FMT-related transmission (Table 1). This was followed by three rounds of the Delphi process generating 21 consensus statements (Table 2), all achieving a consensus of at least 80% except for SARS-CoV-2 (78%). Although fecal-oral transmission of SARS-CoV-2 is unproven, its detection in stool precluded full consensus. Similarly, hepatitis B, hepatitis C, and HIV showed no evidence of FMT-related transmission, though excluding infected donors remains prudent given potential immune and microbiome alterations. Finally, while CMV is typically ... |