Fecal Microbiota Transplantation for Recurrent Clostridioides difficile Infection

This article synthesizes the evidence supporting fecal microbiota transplantation (FMT) as a paradigm-shifting therapy for recurrent Clostridioides difficile infection (rCDI), highlighting the mechanisms, clinical efficacy across populations, and delivery methods. FMT has been shown to increase gut microbial diversity, restore bile acid metabolism, and induce resistance against colonization, resulting in the treatment of rCDI. Randomized controlled trials and meta-analyses of real-world data demonstrate clinical resolution rates of 85% to 90%, with higher cure rates observed after multiple FMTs. We further examine predictors of FMT failure and outcomes in special populations, underscoring the safety and efficacy of FMT in high-risk patients.