Fecal Microbiota Transplantation Effective for Recurrent C Difficile Infections

Tanveer Singh, MD

New research points to fecal microbiota transplantation (FMT) as a viable treatment option for recurrent Clostridioides difficile infections (CDI), but less so for primary CDI.

A team, led by Tanveer Singh, MD, MBBS, Departments of Medicine, Cleveland Clinic, assessed the efficacy of fecal microbiota transplantation compared to medical therapy.

The Therapy

Various clinical trials in the past have shown fecal microbiota transplantation can be a viable therapeutic option for treating patients with C difficile infections.

In the systematic review and meta-analysis, the investigators identified previously published randomized controlled trials that compared fecal microbiota transplantation with medical therapy for patients with C difficile infections.

The investigators sought outcomes of the clinical cure, determined by the resolution of diarrhea and/or negative C difficile testing.

The team also defined primary C difficile infections as the first episode, confirmed either endoscopically or by laboratory analysis, while recurrent C difficile infections were defined as laboratory or endoscopically confirmed episode of CDI following at least 1 course of approved antibiotic regimen.

The Analysis

The investigators identified 7 studies involving 238 patients. However, the results show fecal microbiota transplantation did not have a statistically significant difference compared to medical therapy for clinical cure of combined primary and recurrent CDI following the first session (RR, 1.52; 95% CI, 0.90-2.58; P = 0.12; I² = 78%), as well as after multiple sessions of fecal microbiota transplantation (RR, 1.68; 95% CI, 0.96-2.94; P = 0.07; I² = 82%).

After conducting a subgroup analysis, the investigators found fecal microbiota transplantation had a statistically higher rate of response the medical therapy (RR, 2.41; 95% CI, 1.20-4.83; I² = 78%) for recurrent CDI.

This, however, was not true for primary CDI. Here, there was no statistically significant difference between the 2 treatment options (RR, 1.00; 95% CI, 0.72-1.39; I² = 0%).

“As per our analysis, FMT should not be utilized for every patient with CDI,” the authors wrote. “It is more effective in RCDI, but the results were not significant in patients with primary CDI.”

There are several known risk factors for C difficile infections, including race, gender, and age. For example, women, individuals over 65 years, and Caucasians are all at a higher risk for developing CDI because of reduced diversity of the intestinal microbiome.

However, fecal microbiota transplantation could be a viable option for high risk patients by restoring healthy flora in the gut, breaking the cycle of CDI recurrence.

Fecal Microbiota Transplantation

Earlier this year, a team, led by Muhammad Farhan Ashraf, Institute of Microbiology, University of Agriculture Faisalabad, found evidence that supports the use of fecal microbiota transplantation for recurrent CDI.

In the study, the investigators examined 64 patients at least 16 years of age who had received FMT between October 2015 and November 2019. The patients included appeared in both inpatient and outpatient settings.

At the two-month follow-up mark following the procedure, 75% of participants showed symptomatic improvement, while 15.6% of patients reported no improvements and 9.4% did not follow-up.

In addition, 40.6% (n = 26) participants had CDI recurrence during the follow-up year, while 69.2% of patients with recurrence underwent a repeat fecal microbiota transplantation.

The study, “Fecal Microbiota Transplantation and Medical Therapy for Clostridium difficile Infection,” was published online in Clinical Gastroenterology.