Written by Mary Marschner
Spoon Feed
Fecal microbiota transplantation (FMT) reduced recurrence of C. difficile infections. While guidelines recommend its use after a second recurrence (or third infection), this suggests it should be considered first-line.
Can we C a diff in recurrence rates and mortality with more fecal transplants?
Clostridioides difficile infections (CDI) are common, particularly debilitating in the elderly, and have unacceptably high rates of recurrence despite our current treatments of oral vancomycin, fidaxomicin, or metronidazole, resulting in significant morbidity and mortality.
This multi-site Danish cohort study evaluated the effectiveness of FMT in treating patients with first or second episodes of CDI. The study included 467 patients treated with FMT between June 2019 and February 2023 and demonstrated that repeat FMT achieved a cure rate of 79% (95%CI 75%–82%) with a 90-day mortality rate of 10% (95% CI 8%–14%). These findings suggest that incorporating FMT earlier in CDI treatment protocols may enhance patient survival.
The study had many limitations, including a lack of confirmatory toxin testing after CDI PCR testing for confirmation of active infection. This opens the possibility that some patients who had non-CDI diarrhea may have been included. Additionally, there was no differentiation between fecal microbiota transplantation methods (capsules, enemas, colonoscopies), which have demonstrated differences in treatment efficacy.
How does this change my practice?
FMT availability has expanded from colonoscopy to oral and enema methods, yet high costs remain a barrier. Although this study suggests earlier FMT consideration, significant limitations prevent immediate practice changes, highlighting the need for a large randomized trial comparing vancomycin, fidaxomicin, and FMT at various CDI stages.
Source
Real-world Effectiveness of Fecal Microbiota Transplantation for First or Second Clostridioides difficile Infection. Clin Gastroenterol Hepatol. 2025 Mar;23(4):602-611.e8. doi: 10.1016/j.cgh.2024.05.038. Epub 2024 Jun 11. PMID: 38871148
