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Updated: Oct 28, 2025
Fecal Microbiota Transplantation via Colonoscopy for Recurrent C. difficile Infection
Published on: December 8, 2014
Hospitalized Older Patients with Clostridioides difficile Infection Refractory to Conventional Antibiotic Therapy
Jae Hyun Shin1, Rachel Ann Hays2, Cirle Alcantara Warren1
1Division of Infectious Diseases and International Health, Department of Medicine, School of Medicine, University of Virginia, Charlottesville, VA 22903, USA.
Background:
Options for Clostridioides difficile infection (CDI) refractory to conventional therapy are limited. Fecal microbiota transplant (FMT) is considered safe and effective treatment for recurrent CDI and could be a treatment option for refractory CDI. We investigated the efficacy and safety of FMT in hospitalized patients who were not responding to standard treatments for CDI.
Methods:
Electronic medical records of patients who received FMT inpatient for refractory CDI were reviewed as part of quality improvement efforts to evaluate safety and efficacy of FMT in inpatient setting.
Results:
Between July 2014 and December 2019, 9 patients (age 60-96) received FMT for CDI as inpatient for refractory or fulminant CDI. Most (7 of 9) of these patients had pseudomembranous colitis and underwent multiple FMTs (mean 2.15, range 1 to 3). Five patients had complete resolution and one patient had diarrhea that was C. difficile-negative. There was one recurrent CDI and two deaths, one of which may have been related to FMT or CDI. Compared to recurrent CDI at diagnosis, patients with refractory CDI had higher WBC and neutrophil counts, which decreased after FMT. The overall cure rate of FMT in refractory cases was 66.7%.
Conclusions:
This study shows moderate efficacy of FMT for treatment of refractory CDI although multiple FMT treatment may need to be administered in the presence of pseudomembranous colitis. Inpatient FMT may be an alternative strategy for managing refractory CDI in this population of patients who may not have any effective medical treatment available.
Insights
Fecal microbiota transplant (FMT) offers moderate efficacy for refractory Clostridioides difficile infection (CDI) in hospitalized patients. Multiple FMT treatments may be necessary for severe cases, presenting an alternative therapeutic strategy.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Microbiome Research
Background:
- Limited treatment options exist for Clostridioides difficile infection (CDI) refractory to standard therapies.
- Fecal microbiota transplant (FMT) is a recognized safe and effective treatment for recurrent CDI.
- Investigating FMT for refractory CDI in hospitalized patients is crucial.
Purpose of the Study:
- To evaluate the efficacy and safety of inpatient FMT for refractory CDI.
- To assess FMT as a treatment option for patients unresponsive to conventional CDI therapies.
Main Methods:
- Retrospective review of electronic medical records for patients receiving inpatient FMT for refractory CDI.
- Quality improvement analysis of FMT safety and efficacy in a hospital setting.
Main Results:
- Nine patients (age 60-96) with refractory or fulminant CDI received inpatient FMT.
- Seven patients had pseudomembranous colitis, with an average of 2.15 FMTs administered.
- A 66.7% overall cure rate was observed, with five patients achieving complete resolution. Two deaths occurred, one possibly FMT/CDI-related.
Conclusions:
- Inpatient FMT demonstrates moderate efficacy for treating refractory CDI.
- Multiple FMT treatments may be required for patients with pseudomembranous colitis.
- Inpatient FMT represents a viable alternative for managing refractory CDI when other treatments fail.
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