Avoiding Premature Antibiotic Use in Recurrent Clostridioides difficile Infection After Fecal Microbiota Transplant

Area of Science:

• Microbiology
• Gastroenterology
• Infectious Diseases

Background:

• Recurrent Clostridioides difficile infection (rCDI) poses a significant clinical challenge.
• Fecal microbiota transplantation (FMT) is a key treatment option for refractory rCDI.
• Optimizing post-FMT management is crucial for successful treatment outcomes.

Observation:

• An 86-year-old woman with rCDI received FMT after antibiotic treatment failure.
• Following FMT, the patient experienced transient diarrhea and abdominal pain with positive C. difficile stool tests.
• Despite initial symptoms, antibiotics were withheld due to clinical improvement.

Findings:

• The patient achieved complete resolution of rCDI symptoms without further antibiotic intervention.
• Withholding antibiotics post-FMT allowed for potential donor microbiota engraftment.
• This approach suggests a possible benefit in managing rCDI after FMT.

Implications:

• This case highlights the potential benefit of judiciously withholding antibiotics after FMT in rCDI.
• Further research is needed to establish optimal post-FMT protocols for rCDI.
• Understanding the role of antibiotic stewardship in FMT success is essential.