Fecal microbiota transplantation for treatment of Clostridioides difficile infection

Q: Serial Fecal Microbiota Transplant (FMT) for treatment of Clostridioides difficile infection is more effective than a single administration.

A) True

B) False

Answer: A

At least two (or more)  sequential administrations of FMT are recommended to have optimum results for the treatment of Clostridioides difficile infection. FMT can be used with either fresh or frozen samples. With sequential FMT, the improvement of the symptoms can be up to 90 percent, though a single treatment may result in only 50 percent improvement.

One of the remarkable features of FMT in the treatment of Clostridioides difficile infection is its ability to maintain efficacy for many months or even a couple of years.

Said that FMT is not recommended for patients who have inflammatory bowel disease (IBD) and develop Clostridioides difficile infection. It may flare up the IBD.

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References:

1. Lee CH, Steiner T, Petrof EO, et al. Frozen vs Fresh Fecal Microbiota Transplantation and Clinical Resolution of Diarrhea in Patients With Recurrent Clostridium difficile Infection: A Randomized Clinical Trial. JAMA 2016; 315:142.

2. Mamo Y, Woodworth MH, Wang T, et al. Durability and Long-term Clinical Outcomes of Fecal Microbiota Transplant Treatment in Patients With Recurrent Clostridium difficile Infection. Clin Infect Dis 2018; 66:1705.

3. De Leon LM, Watson JB, Kelly CR. Transient flare of ulcerative colitis after fecal microbiota transplantation for recurrent Clostridium difficile infection. Clin Gastroenterol Hepatol 2013; 11:1036.

4. Fischer M, Kao D, Kelly C, et al. Fecal Microbiota Transplantation is Safe and Efficacious for Recurrent or Refractory Clostridium difficile Infection in Patients with Inflammatory Bowel Disease. Inflamm Bowel Dis 2016; 22:2402.