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Updated: Nov 21, 2025
Fecal Microbiota Transplantation via Colonoscopy for Recurrent C. difficile Infection
Published on: December 8, 2014
Faecal microbiota transplantation for recurrent Clostridioides difficile infection: An updated systematic review and
Simon Mark Dahl Baunwall1, Mads Ming Lee1, Marcel Kjærsgaard Eriksen1
1Department of Hepatology and Gastroenterology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 35, DK-8200 Aarhus N, Denmark.
Background:
Faecal microbiota transplantation (FMT) is effective for recurrent Clostridioides difficile infection (CDI), but inconsistent effect rates and uncertain evidence levels have warranted caution. To clarify, we aimed to establish the evidence of FMT for recurrent CDI, updated across different delivery methods, treatment regimens, and in comparison with standard antibiotics.
Methods:
In this updated systematic review and meta-analysis, we searched PubMed, Scopus, Embase, Web of Science, Clinical Key, and Svemed+ for FMT literature published in English until November 11, 2019. We included observational and clinical trials with or without antibiotic comparators and excluded studies with below 8 weeks follow-up and fewer than 15 patients. The primary outcome was clinical outcome by week 8. We comprehensively extracted patient and procedural data. In a random-effects meta-analysis, we estimated the clinical effect for repeat or single FMT, different delivery methods, and versus antibiotics. We rated the evidence according to the Cochrane and GRADE methods. The PROSPERO preregistration number is CRD42020158112.
Findings:
Of 1816 studies assessed, 45 studies were included. The overall clinical effect week 8 following repeat FMT (24 studies, 1855 patients) was 91% (95% CI: 89-94%, I 2=53%) and 84% (80-88%, I 2=86%) following single FMT (43 studies, 2937 patients). Delivery by lower gastrointestinal endoscopy was superior to all other delivery methods, and repeat FMT significantly increased the treatment effect week 8 (P<0·001). Compared with vancomycin, the number needed to treat (NNT) for repeat FMT was 1·5 (1·3-1·9, P<0·001) and 2.9 (1·5-37·1, P=0·03) for single FMT. Repeat FMT had high quality of evidence.
Interpretation:
High-quality evidence supports FMT is effective for recurrent CDI, but its effect varies with the delivery method and the number of administrations. The superior NNT for FMT compared with antibiotics suggests that patients may benefit from advancing FMT to all instances of recurrent CDI.
Funding:
Innovation Fund Denmark (j.no. 8056-00006B).
Insights
Faecal microbiota transplantation (FMT) is highly effective for recurrent Clostridioides difficile infection (CDI). Repeat FMT and lower gastrointestinal endoscopy delivery show superior outcomes compared to single treatments or antibiotics.
Area of Science:
- Gastroenterology
- Microbiology
- Infectious Diseases
Background:
- Recurrent Clostridioides difficile infection (CDI) presents treatment challenges.
- Faecal microbiota transplantation (FMT) shows promise but requires evidence clarification.
- Inconsistent efficacy rates necessitate updated evidence on FMT for recurrent CDI.
Purpose of the Study:
- To establish the evidence for FMT in treating recurrent CDI.
- To evaluate FMT efficacy across various delivery methods and treatment regimens.
- To compare FMT effectiveness against standard antibiotic treatments.
Main Methods:
- Systematic review and meta-analysis of 45 studies (1816 assessed).
- Inclusion of observational and clinical trials with follow-up >8 weeks and >15 patients.
- Random-effects meta-analysis of clinical outcomes at week 8, comparing single vs. repeat FMT, delivery methods, and antibiotics.
Main Results:
- Overall clinical effect at week 8: 91% for repeat FMT (24 studies) and 84% for single FMT (43 studies).
- Lower gastrointestinal endoscopy delivery was superior; repeat FMT significantly increased treatment effect (P<0.001).
- Repeat FMT showed a superior Number Needed to Treat (NNT) compared to vancomycin (1.5 vs. 2.9).
Conclusions:
- High-quality evidence confirms FMT effectiveness for recurrent CDI.
- FMT efficacy is influenced by delivery method and number of administrations.
- FMT may be beneficial for all instances of recurrent CDI due to superior NNT compared to antibiotics.
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