Faecal microbiota transplantation in the treatment of Clostridioides difficile infection

Abstract

Faecal microbiota transplantation (FMT) represents a unique procedure targeted to restoring the natural diversity of the gastrointestinal microbiome and prevent recurrence of a key nosocomial disease, namely, Clostridioides difficile infection (CDI). The aim of the present study was assessing the success rate and clinical efficacy of FMT at a clinic that introduced this procedure in Czechia in 2010 and still leads in the number of transplantations performed to date. Patients enrolled in the study received primary targeted antibiotic therapy, and after the CDI episode treatment, FMT administered as a secondary prophylaxis. After the procedure, patients were followed up. The treatment was defined as successful if colitis did not recur within 8 weeks. Logistic regression analysis was used for determining the odds ratios for the individual factor variants (patient age and sex, number of previous recurrences, severity of the treated CDI episodes, presence of chronic comorbidities, performance status, initial antibiotic treatment, mode of faecal-transplant application and use of fresh or frozen stool). In the 4-year interval involved (2015–2018), 172 patients were treated using faecal microbiota transplantation. The overall success rate was 76%. Subgroup analysis identified higher age, higher Charlson Comorbidity Index reflecting the presence and severity of long-term comorbidities and higher Eastern Cooperative Oncology Group (ECOG) performance scores as risk factors for treatment failure. In the period monitored, two serious adverse events were observed: Both were rectal-wall perforations occurring during the application of enemas of stool suspension. There was no lethality.