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Updated: Oct 7, 2025
Fecal Microbiota Transplantation via Colonoscopy for Recurrent C. difficile Infection
Published on: December 8, 2014
Fecal Microbiota Transplant for Clostridioides Difficile Infection Is Safe and Efficacious in an Immunocompromised
Kelly Suchman1, Yuying Luo2, Ari Grinspan2
1Department of Internal Medicine, Northshore Hospital, Barbara and Zucker School of Medicine for Hofstra/Northwell Health, 300 Community Drive, Manhasset, NY, 11030, USA. Ksuchman@northwell.edu.
Background:
Immunocompromised patients are particularly vulnerable to Clostridioides difficile infection (CDI), hospitalizations and recurrences. Studies have shown that fecal microbiota transplant (FMT) is safe and effective in immunocompromised patients.
Aims:
To examine the outcomes of FMT for CDI in a diverse cohort of immunocompromised patients stratified by medication class.
Methods:
We performed a retrospective, long-term follow-up study of FMT in immunocompromised patients, including those undergoing chemotherapy, with inflammatory bowel disease (IBD) on immunomodulators, prior solid organ transplant on immunosuppressants, on chronic steroids 20 mg/day or higher for a minimum of three months, or HIV positive. Primary outcomes included adjusted primary cure rate within 8 weeks, as well as rates of non-response, recurrences, relapses and adverse events. Secondary outcomes included adjusted overall cure rate. Primary cure rate was defined as patients not requiring repeat CDI treatment within 8 weeks after index FMT, and overall cure rate was defined as resolution of CDI symptoms after index FMT or second FMT.
Results:
Our cohort included 77 immunosuppressed patients (53.2% female, median age 39.1 years, range 7-95 years). The majority of our cohort were IBD patients on biologics (62.3%). Adjusting for colectomies and deaths, our primary and overall cure rates were 85.1% and 86.5%, respectively. Twelve patients received FMT for severe or fulminant CDI with a 3-month survival rate of 91.7%. 11.7% of patients experienced serious adverse events following FMT.
Conclusions:
Our study supports the efficacy and safety of FMT in immunocompromised patients, though future research is needed to further ascertain the potential effects of immunosuppression on FMT outcomes.
Insights
Fecal microbiota transplant (FMT) is effective for treating Clostridioides difficile infection (CDI) in immunocompromised patients. This study found high cure rates and manageable adverse events, supporting FMT
Area of Science:
- Gastroenterology
- Infectious Diseases
- Immunology
Background:
- Immunocompromised patients face high risks of Clostridioides difficile infection (CDI), leading to frequent hospitalizations and recurrences.
- Fecal microbiota transplant (FMT) has emerged as a promising therapeutic option for CDI in this vulnerable population.
- Existing research suggests FMT is both safe and effective for immunocompromised individuals.
Purpose of the Study:
- To evaluate the efficacy and safety of FMT in a diverse group of immunocompromised patients.
- To stratify outcomes based on specific medication classes and underlying conditions.
- To assess primary and secondary cure rates, recurrence, and adverse events following FMT.
Main Methods:
- A retrospective, long-term follow-up study was conducted.
- The cohort included immunocompromised patients with various conditions (chemotherapy, IBD, organ transplant, chronic steroids, HIV).
- Outcomes measured included primary cure (8 weeks), overall cure, recurrence, relapse, and adverse events.
Main Results:
- The study included 77 immunocompromised patients, with 62.3% having inflammatory bowel disease (IBD) on biologics.
- Adjusted primary and overall cure rates were 85.1% and 86.5%, respectively.
- Serious adverse events occurred in 11.7% of patients; 12 patients with severe CDI had a 3-month survival rate of 91.7%.
Conclusions:
- Fecal microbiota transplant (FMT) demonstrates significant efficacy and a favorable safety profile in immunocompromised patients with CDI.
- The study supports FMT as a viable treatment option for this high-risk group.
- Further research is warranted to explore the nuanced impact of immunosuppression on FMT outcomes.
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