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Fresh fecal microbiota transplantation (FMT) is a microbial therapy involving the transfer of minimally processed stool from a healthy donor to a patient, typically within 6 to 24 hours of collection. The primary mechanism of action is the restoration of a diverse and functional intestinal microbiome, which provides colonization resistance against pathogens like *Clostridioides difficile*. By reintroducing a complex community of commensal bacteria, fungi, and viruses, FMT outcompetes *C. difficile* for nutrients and niche space, and restores bile acid metabolism, which inhibits *C. difficile* germination and growth. Fresh FMT is often compared to frozen-and-thawed preparations in clinical trials to evaluate whether the lack of cryopreservation offers superior efficacy or safety in treating recurrent infections.
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