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Updated: Oct 4, 2025
Fecal Microbiota Transplantation via Colonoscopy for Recurrent C. difficile Infection
Published on: December 8, 2014
Fecal Microbiota Transplantation for Severe or Fulminant Clostridioides difficile Infection: Systematic Review and
Yi Nong Song1, David Yi Yang1, Sander Veldhuyzen van Zanten1
1Division of Gastroenterology, University of Alberta, Edmonton, Alberta,Canada.
Background:
Severe or fulminant Clostridioides difficile infection (SFCDI) is associated with significant morbidity and mortality. Emerging evidence suggests fecal microbiota transplant (FMT) may be a promising therapy for SFCDI.
Aim:
This systematic review determines the safety and efficacy of FMT in medically refractory SFCDI.
Methods:
A systematic search of the literature was conducted using PubMed (1965 to 2020), Web of Science (1900 to 20), EMBASE (1974 to 2020), and Cochrane Review (1945 to 2020). Quality appraisal by NIH Study Quality Assessment tools, and data extraction were performed by two teams of independent researchers. The primary outcome was resolution of SFCDI 4 weeks after the final FMT. Pooled resolution rates were calculated using generalized linear mixed models estimates.
Results:
Two hundred and forty patients from 10 studies (8 case series, 1 case-control and 1 randomized study) were included with 209 individual patient-level data. FMT resulted in resolution of SFCDI within 4 weeks in 211/240 individuals for a pooled estimate of 88% (95% confidence interval [CI]: 0.83 to 0.91). The mean number of FMT required was 1.6 for severe and 2.0 for fulminant CDI resolution. The pooled proportional estimates for patients requiring CDI-directed antimicrobials after FMT was 50% (95% CI: 0.06 to 0.94) for severe CDI and 67.0% (95% CI: 0.30 to 0.91) for fulminant CDI. Serious adverse event rates were low.
Conclusion:
FMT appears effective in treating SFCDI patients with low adverse events, but requires multiple treatments with a significant proportion of patients requiring additional anti-CDI antibiotics to achieve resolution. The optimal route of FMT delivery remains unknown. The presence of pseudomembranous colitis may guide additional FMT or anti-CDI antibiotic treatment.
Insights
Fecal microbiota transplant (FMT) effectively treats severe or fulminant Clostridioides difficile infection (SFCDI) in 88% of patients. However, multiple treatments and additional antibiotics are often necessary for resolution, with low adverse events reported.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Microbiome Research
Background:
- Severe or fulminant *Clostridioides difficile* infection (SFCDI) presents significant morbidity and mortality.
- Fecal microbiota transplant (FMT) is an emerging therapeutic option for SFCDI.
Purpose of the Study:
- To systematically review the safety and efficacy of FMT for medically refractory SFCDI.
- To determine pooled resolution rates and adverse event profiles associated with FMT in SFCDI.
Main Methods:
- Systematic literature search across major databases (PubMed, Web of Science, EMBASE, Cochrane Review) from 1900s to 2020.
- Quality appraisal using NIH tools and data extraction by independent researchers.
- Pooled resolution rates calculated using generalized linear mixed models, with primary outcome at 4 weeks post-FMT.
Main Results:
- Included 240 patients from 10 studies; 209 with individual patient-level data.
- FMT achieved SFCDI resolution in 88% of patients within 4 weeks (95% CI: 0.83–0.91).
- Mean FMT treatments were 1.6 for severe and 2.0 for fulminant CDI; 50-67% required additional antibiotics.
Conclusions:
- FMT demonstrates efficacy in treating SFCDI with a low rate of serious adverse events.
- Multiple FMT treatments and subsequent antibiotic use are often required for resolution.
- Optimal FMT delivery route and role of pseudomembranous colitis in treatment guidance warrant further investigation.
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