Faecal Microbiota Transplantation is Effective for the Initial Treatment of Clostridium difficile Infection: A Retrospective Clinical Review

Abstract

Introduction: Clostridium difficile (C. difficile) infection (CDI) is commonly recognised as a nosocomial infection but is increasingly identified in patients in the community. Antimicrobial exposure which compromises gut microbiota is the main risk factor for CDI, although antibiotics remain the main treatment for this infection. Faecal microbiota transplantation (FMT) is also an effective treatment for CDI. FMT involves the transfer of microbiota from a healthy donor to an unwell patient. Currently FMT is mostly used after repeated antibiotic treatments fail to cure CDI. This study investigated the effect of FMT as first-line treatment for CDI to avoid repeated antibiotic damage of the microbiome. Methods: This retrospective, single-centre study included 59 patients between 2012 and 2017 whose first episode of CDI was treated with FMT. The patients' symptoms and presence of C. difficile in stool samples both at the baseline and post treatment were documented. Results: Fifty-four patients completed a final stool test 4-8 weeks post treatment in which 98% of patients were negative for C. difficile. There were no adverse effects. There was a significant reduction in abdominal pain, diarrhoea, bloating and blood in the stool at 4-8 weeks post treatment. Data from 24 patients who completed an extended 6 months followup showed significant reduction in abdominal pain, diarrhoea and blood in the stool. Conclusion: This study demonstrates the safety and efficacy of FMT as first-line treatment for patients' initial episode of CDI. Future randomised studies are required to confirm FMT as the initial treatment for CDI.

Altered gut microbial metabolites could mediate the effects of risk factors in Covid‐19

“…In addition, the extensive use of antibiotics is a causal factor for gut dysbiosis when prescribed for the prevention of secondary bacterial infections in Covid‐19. It is well known that the use of antibiotics can cause gut microbiota alterations and subsequent transluminal mucosa transfer of endotoxins (e.g., lipopolysaccharides [LPS]) from opportunistic pathogens 48 . For example, antibiotics have been associated with Clostridium difficile infections, and faecal microbiome transplantation has been used successfully for the treatment of the disease 49 ,.…”

Faecal Microbiota Transplantation as Primary Treatment for Clostridioidoes difficile Infection-evidence for Change

“…98% of the 58/59 patients were cleared of C. difficile as verified by culture and toxin testing over the next 4-8 weeks. There were also statistically significant symptomatic reductions in abdominal pain, diarrhoea, and blood in the stool [6].…”

“…In many cases, patients had been treated with several courses of Vancomycin with several failures to cure when tapering antibiotics. To investigate the effectiveness of FMT on their first episode of CDI diagnosis Roshan et al completed a retrospective, single-centre study of 59 patients between 2012 and 2017 treated with FMT on their first episode of CDI [6]. In light of strong evidence that repeated FMT (more than one) leads to increased efficacy rates, all patients were first treated with colonoscopic infusion, followed by an enema the next day.…”

“…On the other hand, there is now considerable evidence that (FMT) effectively cures CDI and may emerge as an effective initial treatment of CDI even in patients diagnosed with CDI for the first time [5]. There is now evidence to demonstrate a cure rate of up to 98% when more than one FMT infusion is performed [6,7]. Despite this growing new data, the FDA guidelines may be holding physicians back from curing more CDI patients.…”

Molecular Communication Between Neuronal Networks and Intestinal Epithelial Cells in Gut Inflammation and Parkinson's Disease

“…A recent study demonstrates the efficacy of this strategy in an experimental colitis model induced by adoptive transfer of naïve T cells, since transfer of healthy vs. IBD patient fecal content permits restoration of T cell responses (decreased Th17/Th2); and increased Treg/IFNγ and ameliorates thereby colitis (174). Despite limitations based on the donor testing, the limited duration of the treatment and the potential alterations upon antibiotic treatment, FMT it is approved for the treatment of other intestinal conditions, such as Clostridium difficile infections (175,176). In addition to fecal transplantation, a recent review collects other therapy strategies based on the modulation of the microbiota via direct or indirect mechanisms, such as enteral nutrition; pre-, pro-, and post-biotics; inhibition of Adherent-invasive Escherichia coli (AIEC) adhesion and tungstate treatment (168).…”