New research indicates that fecal microbiota transplantation (FMT) is 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, evaluated the effectiveness of fecal microbiota transplantation versus medical treatment.
Various clinical trials in the past have shown that fecal microbiota transplantation may be a viable therapeutic option for treating patients with C difficile infections.
In the systematic review and meta-analysis, researchers identified previously published randomized controlled trials that compared fecal microbiota transplantation to medical treatment for patients with C difficile infections.
The researchers looked for clinical cure results, determined by resolution of the diarrhea and / or negative tests for C difficile.
The team also defined primary C difficile infections as the first episode, confirmed either by endoscopy or laboratory analysis, while recurrent C difficile infections were defined as an episode of CDI confirmed in the laboratory or by laboratory testing. endoscopy after at least 1 approved antibiotic treatment.
The investigators identified 7 studies involving 238 patients. However, the results show that fecal microbiota transplantation did not have a statistically significant difference from medical treatment for clinical cure of primary and recurrent combined CDI after the first session (RR: 1.52; CI at 95%: 0.90-2.58; P = 0.12; I2 = 78%), as well as after several 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 that fecal microbiota transplantation had a statistically higher response rate to medical treatment (RR: 2.41; 95% CI: 1.20-4.83 ; I2 = 78%) for recurring CDIs.
This, however, was not true for the 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%).
“Based on our analysis, FMT should not be used for all patients 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, people over 65, and Caucasians all have a higher risk of developing CDI due to reduced gut microbiome diversity.
However, fecal microbiota transplantation could be a viable option for high-risk patients by restoring healthy gut flora, thereby breaking the cycle of recurrence of CDI.
Faecal microbiota transplantation
Earlier this year, a team led by Muhammad Farhan Ashraf, of the Institute of Microbiology at Faisalabad University of Agriculture, 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 hospital and outpatient settings.
After two months of follow-up after the procedure, 75% of participants showed improvement in symptoms, while 15.6% of patients reported no improvement and 9.4% did not follow up.
Additionally, 40.6% (n = 26) of participants had a recurrence of CDI within the year of follow-up, while 69.2% of patients with recurrence underwent a new fecal microbiota transplant.
The study, “Faecal microbiota transplantation and medical treatment of Clostridium difficile infection, âWas published online in Clinical gastroenterology.