Does Fecal Microbiota Transplant Prevent Recurrent C. difficile Infection?

Deronda DM, Shaukat A, Huang Y, et al. A Randomized Controlled Trial of Efficacy and Safety of Fecal Microbiota Transplant for Preventing Recurrent Chloridoids difficile Infection. Clin Infect Dis. 2024; in press.

Poutanen SM, Hota SS. Deja vu: Unanswered Questions about Fecal Microbiota Transplantation for Recurrent Chloridoids difficile Infection. Clin Infect Dis. 2024; in press.

Data cited in the article by Drekonja and Hota showed that C. difficile infection is the most common healthcare-associated infection in the US, and recurrence is documented in up to one-third of infected patients. Fecal microbiota transplant (FMT) is the treatment recommended by clinical practice guidelines.

The randomized, prospective trial reported in this article compared outcomes in 152 patients from the Veterans Administration Health System who were diagnosed with recurrent C. difficile infection and treated with FMT or placebo. The outcomes of interest were recurrence of infection (defined as clinical diarrhea) at 56 days or less or death.

The data analysis showed that outcomes and rates of adverse events in the two comparison groups were not statistically different. The authors noted that most of the patients enrolled in the study had a single recurrence.

They concluded that FMT did not reduce the risk of recurrence following FMT treatment.

The accompanying editorial by Poutanen and Hota emphasized that the trial protocol of a single dose of FMT administered early after diagnosis of recurrence may have influenced the outcome. They recommended that FMT remain the treatment of choice in patients with more than one recurrence of C. difficile infection.