Faecal Microbiota Transplantation is Effective for the Initial Treatment of Clostridium difficile Infection: A Retrospec
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ORIGINAL RESEARCH
Faecal Microbiota Transplantation is Effective for the Initial Treatment of Clostridium difficile Infection: A Retrospective Clinical Review Niloufar Roshan . Annabel K. Clancy . Thomas J. Borody
Received: July 1, 2020 / Accepted: September 3, 2020 Ó The Author(s) 2020
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. Keywords: Clostridium difficile; Faecal microbiota transplantation; Gut microbiota
Digital Features To view digital features for this article go to https://doi.org/10.6084/m9.figshare.12907031 N. Roshan A. K. Clancy T. J. Borody (&) Centre for Digestive Diseases, Five Dock, NSW, Australia e-mail: [email protected]
Infect Dis Ther
Key Summary Points Why carry out the study? In the USA, the Food and Drug Administration (FDA) mandates that CDI can only be treated with FMT after two treatment failures with antibiotics Given CDI often follows antibiotic use, and the high efficacy of FMT in the treatment of recurrent CDI it makes sense to treat with FMT early, to eradicate CDI This study aimed to investigate the safety, efficacy and clinical outcomes in patients with a first episode of CDI treated with FMT as first-line therapy What was learned from the study? First-line treatment with FMT demonstrated high efficacy (98% eradication), low rates of recurrence, resolution of symptoms and no adverse events This study demonstrates the efficacy and safety of FMT treatment for patients with a first episode of CD
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