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Updated: Nov 26, 2025
Fecal Microbiota Transplantation via Colonoscopy for Recurrent C. difficile Infection
Published on: December 8, 2014
Long-term Outcomes Following Multiply Recurrent Clostridioides difficile Infection and Fecal Microbiota
Ghadeer K Dawwas1, Colleen M Brensinger1, Ravy K Vajravelu2
1Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania.
Background And Aims:
Fecal microbiota transplantation (FMT) is a commonly used therapy for multiply recurrent Clostridioides difficile (mrCDI). By altering the gut microbiota, there is the potential for FMT to impact the risk for cardiometabolic, intestinal or immune-mediated conditions. Likewise, the microbiota disturbance associated with mrCDI could potentially lead to these conditions. We aimed to assess the associations of mrCDI and FMT with cardiometabolic, immune-mediated diseases, and irritable bowel syndrome.
Methods:
This retrospective cohort study using a United States commercial claims database included persons diagnosed with CDI or undergoing FMT. We created 2 pairwise comparisons: mrCDI vs non-mrCDI, and non-mrCDI or mrCDI treated with FMT vs mrCDI without FMT.
Results:
We found no significant association between mrCDI (vs non-mrCDI) and inflammatory bowel disease (adjusted hazard ratio (aHR) = 1.65; 95% confidence interval, 0.67-4.04), rheumatoid arthritis (HR = 0.86; 0.47-1.56), psoriasis (HR = 0.72; 0.23-2.27), diabetes (aHR = 0.97; 0.67-1.40), hypertension (aHR = 1.05; 0.76-1.44), myocardial infarction (aHR = 0.82; 0.63-1.06), stroke (aHR = 0.83; 0.62-1.12), or irritable bowel syndrome (HR = 0.94; 0.61-1.45). Similarly, we found no association of CDI with FMT (vs mrCDI without FMT) and diabetes (aHR = 0.92; 0.27-3.11), hypertension (aHR = 1.41; 0.64-3.15), stroke (aHR = 1.27; 0.69-2.34) or inflammatory bowel syndrome (aHR = 0.80; 0.26-2.46). However, the incidence of myocardial infarction was increased following FMT (aHR = 1.68; 1.01-2.81).
Conclusion:
Relative to those with CDI, persons with mrCDI do not appear to be intrinsically at higher risk of cardiometabolic, immune-mediated diseases, or irritable bowel syndrome. However, those who underwent FMT for CDI had a higher incidence of myocardial infarction. Future studies should assess this association to assess reproducibility.
Insights
Fecal microbiota transplantation (FMT) for recurrent C. difficile infection (rCDI) did not show associations with major cardiometabolic or immune diseases. However, FMT was linked to an increased risk of myocardial infarction.
Area of Science:
- Gastroenterology
- Microbiome Research
- Cardiology
Background:
- Recurrent Clostridioides difficile infection (mrCDI) and its treatment, fecal microbiota transplantation (FMT), may influence cardiometabolic and immune-mediated conditions due to gut microbiota alterations.
- The gut dysbiosis associated with mrCDI itself could potentially contribute to these health issues.
Purpose of the Study:
- To investigate the associations between mrCDI and FMT with the risk of developing cardiometabolic diseases, immune-mediated conditions, and irritable bowel syndrome.
- To determine if mrCDI increases intrinsic risk for these conditions or if FMT influences their incidence.
Main Methods:
- A retrospective cohort study utilized a United States commercial claims database.
- Included individuals diagnosed with CDI or undergoing FMT.
- Two primary comparisons were made: mrCDI vs. non-mrCDI, and FMT-treated mrCDI vs. untreated mrCDI.
Main Results:
- No significant associations were found between mrCDI and inflammatory bowel disease, rheumatoid arthritis, psoriasis, diabetes, hypertension, myocardial infarction, stroke, or irritable bowel syndrome.
- Similarly, no associations were observed between CDI treated with FMT versus CDI without FMT for diabetes, hypertension, stroke, or irritable bowel syndrome.
- A notable finding was an increased incidence of myocardial infarction following FMT (aHR = 1.68; 1.01-2.81).
Conclusions:
- Individuals with mrCDI do not appear to have a higher intrinsic risk for cardiometabolic, immune-mediated diseases, or irritable bowel syndrome compared to those with CDI.
- Fecal microbiota transplantation (FMT) for CDI was associated with a higher incidence of myocardial infarction.
- Further research is recommended to confirm and understand the association between FMT and myocardial infarction risk.
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