Fecal Microbiota Transfer for Recurrent Clostridioides difficile Infection: A Retrospective Single-Center Analysis

Clostridioides difficile infection (CDI) is the leading cause of healthcare-associated infectious diarrhea. Despite high initial response rates to antibiotic therapy, recurrence occurs in approximately 20% of patients. Fecal microbiota transplantation (FMT) has emerged as an effective treatment option for multiple recurrences, demonstrating high efficacy and a favorable safety profile. This study aimed to evaluate the effectiveness and safety of FMT in patients with recurrent CDI (rCDI).

In this single-center retrospective study, 75 patients who underwent FMT for rCDI between November 2016 and January 2026 after experiencing at least two recurrences despite standard antibiotic therapy were included. Donor screening was performed according to the requirements of the German Federal Institute for Drugs and Medical Devices (BfArM). Following CDI-directed antibiotic pretreatment, FMT was administered either by colonoscopy, oral capsules, or a combination of both. Patients were followed for three months. The primary endpoint was the absence of diarrhea as a surrogate marker for rCDI, including a predefined subgroup analysis of patients with inflammatory bowel disease (IBD).

Follow-up data were available for 65 patients, of whom 56 (86.1%) achieved sustained clinical remission. Patients with concomitant IBD (n=15) showed a comparable response rate (86.7%). The route of FMT administration had no significant impact on treatment outcome. Overall, FMT was well tolerated, with only four patients (5.3%) reporting predominantly self-limiting adverse events.

FMT is a highly effective and safe treatment for recurrent CDI, including in multimorbid patients and those with concomitant IBD.