Fecal calprotectin and need of multiple microbiota trasplantation infusions in Clostridium difficile infection
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Updated: Dec 24, 2025
Fecal Microbiota Transplantation via Colonoscopy for Recurrent C. difficile Infection
Published on: December 8, 2014
Antonella Gallo1, Cristina Cancelli1, Emily Ceron1
1UOC Clinica Medica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Background And Aim:
Fecal microbiota transplantation (FMT) has proven to be very effective in recurrent Clostridium difficile infection (CDI) when compared with standard antibiotic therapy. However, given the lack of validated criteria, decision regarding number and timing of infusions is currently based on the clinician's experience, severity of infection, and clinical response. We performed a longitudinal assessment of fecal calprotectin concentration (FCC) in CDI patients undergoing FMT. FCCs were correlated with the need for multiple infusions and with the clinical status of the patient.
Methods:
Fecal calprotectin concentration measurement was performed just before first procedure (T0 ) and 2 (T1 ) and 5 (T2 ) days later. The need for reinfusion was accounted for in the 8 weeks following procedure, and clinical status was evaluated at the end of the given period. Both outcomes were correlated with measured FCCs.
Results:
A total of 28 CDI patients undergoing FMT were enrolled. Median FCCs at T0 were significantly higher in patients who needed repeat FMT, 540 μg/g versus patients who underwent single FMT, 290 μg/g (P < 0.05). Differences were not significant for FCC at T1 and T2 . Regarding correlation with clinical outcome, median FCC at T0 was found to be lower in responders compared with non-responders with a trend towards statistical significance (P = 0.07). Correlation at T1 and T2 was not significant.
Conclusions:
The use of an easily obtainable parameter such as fecal calprotectin could possibly optimize overall management of FMT procedural framework potentially being able to immediately identify patients who may benefit from repeat infusions.
Insights
Fecal calprotectin concentration measured before fecal microbiota transplantation (FMT) can predict the need for repeat infusions in recurrent Clostridium difficile infection (CDI) patients. This marker may help optimize FMT management.
Area of Science:
- Gastroenterology
- Microbiology
- Clinical Medicine
Background:
- Fecal microbiota transplantation (FMT) is effective for recurrent Clostridium difficile infection (CDI).
- Current FMT protocols lack validated criteria for determining the number and timing of infusions.
- Clinician experience, infection severity, and clinical response guide current FMT decisions.
Purpose of the Study:
- To assess fecal calprotectin concentration (FCC) in CDI patients undergoing FMT.
- To correlate FCC with the need for multiple FMT infusions.
- To correlate FCC with the clinical status of CDI patients post-FMT.
Main Methods:
- Fecal calprotectin concentration (FCC) was measured before the first FMT (T0) and 2 (T1) and 5 (T2) days later.
- The need for reinfusion was tracked for 8 weeks post-procedure.
- Clinical status was evaluated at the end of the 8-week period and correlated with FCC.
Main Results:
- Higher median FCC at T0 was observed in patients requiring repeat FMT (540 μg/g) compared to single FMT (290 μg/g) (P < 0.05).
- FCC levels at T1 and T2 did not show significant differences between groups.
- A trend towards lower FCC at T0 in clinical responders versus non-responders was noted (P = 0.07).
Conclusions:
- Pre-FMT fecal calprotectin concentration may identify CDI patients likely to require repeat infusions.
- FCC is a potentially valuable, easily obtainable biomarker for optimizing FMT management.
- This marker could aid in immediate identification of patients benefiting from repeat FMT procedures.
