A systematic review of published evidence suggests that fecal microbiota transplantation resolves symptoms in patients with recurrent Clostridium difficile infection (CDI) with few short-term adverse events. The results are published in Annals of Internal Medicine.
Clostridium difficile is a bacterium that releases toxins into the intestines causing infectious diarrhea. While the condition was previously linked to health care exposure, it now also affects persons with no or limited contact with the health care system. A key challenge with CDI is its high rate of recurrence and subsequent limited response to antimicrobial treatment. These suboptimal response rates have spurred investigation of additional treatment options, including fecal transplant.
Researchers reviewed published evidence about the benefits and harms of fecal transplant for recurrent, refractory, and initial CDI and looked for evidence that the effectiveness varied by method of transplantation. While the researchers noted a shortage of research (2 RCTs and 28 case-series studies), they saw a large positive effect with fecal transplant for CDI, both in the RCTs and case-series studies. Overall success was 85 percent for recurrent disease and 55 percent for refractory disease-rates that are substantially higher than the 30 percent to 80 percent typically reported with various medical therapies. The researchers found insufficient evidence to determine whether treatment effects vary by donor, preparation, or delivery method.
Fecal Microbiota Transplantation for Clostridium difficile Infection: A Systematic Review, D. Drekonja, J. Reich, S. Gezahegn, N. Greer, A. Shaukat, R. MacDonald, I. Rutks, and T.J. Wilt, Annals of Internal Medicine, doi: 10.7326/M14-2693, published 4 May 2015.