Clostridium difficile Infection and Fecal Microbiota Transplant

Abstract

Clostridium difficile infection (CDI) is a major source of morbidity and mortality for hospitalized patients. Although most patients have a clinical response to existing antimicrobial therapies, recurrent infection develops in up to 30% of patients. Fecal microbiota transplant is a novel approach to this complex problem, with an efficacy rate of nearly 90% in the setting of multiple recurrent CDI. This review covers the current epidemiology of CDI (including toxigenic and nontoxigenic strains, risk factors for infection, and recurrent infection), methods of diagnosis, existing first-line therapies in CDI, the role of fecal microbiota transplant for multiple recurrent CDIs, and the potential use of fecal microbial transplant for patients with severe or refractory infection.

Keywords: Clostridium difficile infection; fecal microbiota transplant; fecal transplant; recurrent C difficile infection.

Figure

Proposed clinical algorithm for the management of recurrent Clostridium difficile infection (CDI). Note that the specific choice of antibiotics may vary. The most common prolonged antibiotic course would be a 6-week oral vancomycin taper; however, other prolonged courses may be acceptable as well. Before fecal microbiota transplant (FMT), the patient should be treated with antibiotics for at least 10 to 14 days to control the infection. *Although guidelines suggest that the same antibiotics can be used for the first recurrence, we recommend using vancomycin or fidaxomicin.