Abstract
Oral vancomycin and metronidazole, though they are the therapeutic choice for Clostridioides difficile infections (CDIs), also markedly disturb microbiota, leading to a prolonged loss of colonization resistance to C. difficile after therapy; as a result, their use is associated with a high treatment failure rate and high recurrent rate. An alternative for CDIs therapy contains the delivery of beneficial (probiotic) microorganisms into the intestinal tract to restore the microbial balance. Recently, mixture regimens containing Lactobacillus species, Saccharomyces boulardii, or Clostridium butyricum have been extensively studied for the prophylaxis of CDIs. Fecal microbiota transplantation (FMT), the transfer of (processed) fecal material from healthy donors to patients for treating CDIs, combined with vancomycin was recommended as the primary therapy for multiple recurrent CDIs (rCDIs). Either probiotics or FMT have been utilized extensively in preventing or treating CDIs, aiming at less disturbance in the microbiota to prevent rCDIs after therapy cessation. Otherwise, many newly developed therapeutic agents have been developed and aim to preserve microbiota during CDI treatment to prevent disease recurrence and might be useful in clinical patients with rCDIs in the future.
Highlights
Clostridioides difficile, as the major cause of antibiotic-associated diarrhea, has clinical symptoms ranging from diarrhea to pseudomembranous colitis or toxic megacolon, with a mortality rate of up to 25–40% [1,2,3,4,5]
Antimicrobial resistance is2noof t14 clinically problematic, treating C. difficile infection (CDI) with metronidazole and vancomycin is associated with a high treatment failure rate and recurrence rate [8]
Fecal microbiota transplantation (FMT), the transfer of fecal material from healthy donors to CDI patients, combined with vancomycin have been recommended as the primary therapy for multiple recurrent C. difficile infection (rCDI) [15] (Table 1)
Summary
Reduced beta diversity differences between the donors and recipients, and increased in relative abundance of F. prausnitzii. Decreased number and diversity of antibiotic resistance genes and increased Bacteroidetes and Firmicutes with reduced Proteobacteria. Prevented recurrent CDI for minimum of 3 months post-FMT in all patients. FMT moves the microbiota of recipients towards that of the donor and improves bacterial diversity. CDI recurrence rate after FMT: 84% in capsule group; 88% in FMT enema group, p = 0.76 Both products normalized fecal microbiota diversity while the lyophilized orally administered product was less effective in repleting Bacteroidia and Verrucomicrobia classes compared to frozen product via enema. Recipients with rCDI successfully treated with FMT were included, Specific donor-derived bifidobacterium can colonize rCDI patients for at least one year. The selection of appropriate fecal donors and recipients is an important issue in performing FMT
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