Efficacy and Safety of Fecal Microbiota Transplantation for Recurrent Clostridioides difficile Infection: A Systematic Review

Abstract

Introduction: Recurrent Clostridioides difficile infection (rCDI) is a major clinical challenge with high rates of treatment failure. Fecal Microbiota Transplantation (FMT) aims to restore a healthy gut microbiome to break the cycle of recurrence. This review assesses the evidence for its use.

Methods: A systematic search of RCTs was performed, comparing FMT (delivered via colonoscopy, enema, or capsules) to standard-of-care antibiotics (e.g., vancomycin) or placebo for the treatment of rCDI. The primary outcome was clinical resolution of diarrhea without recurrence.

Results: The meta-analysis included 12 RCTs. FMT was overwhelmingly superior to control therapies, achieving clinical resolution in approximately 85-90% of patients, compared to 30-50% in control arms. All delivery methods of FMT were effective. Short-term adverse events were typically mild and transient.

Discussion: FMT is a highly effective therapy for rCDI, fundamentally addressing the underlying dysbiosis that perpetuates the infection. Standardization of donor screening and preparation is crucial for ensuring safety.

Conclusion: Fecal Microbiota Transplantation is a highly effective and safe treatment for preventing further recurrence in patients with recurrent C. difficile infection.