The Efficacy and Safety of Fecal Microbiota Transplant for Recurrent Clostridiumdifficile Infection: Current Understanding and Gap Analysis

MH Wilcox, BH McGovern… - Open forum infectious …, 2020 - academic.oup.com
MH Wilcox, BH McGovern, GA Hecht
Open forum infectious diseases, 2020academic.oup.com
The leading risk factor for Clostridioides (Clostridium) difficile infection (CDI) is broad-
spectrum antibiotics, which lead to low microbial diversity, or dysbiosis. Current therapeutic
strategies for CDI are insufficient, as they do not address the key role of the microbiome in
preventing C. difficile spore germination into toxin-producing vegetative bacteria, which
leads to symptomatic disease. Fecal microbiota transplant (FMT) appears to reduce the risk
of recurrent CDI through microbiome restoration. However, a wide range of efficacy rates …
Abstract
The leading risk factor for Clostridioides (Clostridium) difficile infection (CDI) is broad-spectrum antibiotics, which lead to low microbial diversity, or dysbiosis. Current therapeutic strategies for CDI are insufficient, as they do not address the key role of the microbiome in preventing C. difficile spore germination into toxin-producing vegetative bacteria, which leads to symptomatic disease. Fecal microbiota transplant (FMT) appears to reduce the risk of recurrent CDI through microbiome restoration. However, a wide range of efficacy rates have been reported, and few placebo-controlled trials have been conducted, limiting our understanding of FMT efficacy and safety. We discuss the current knowledge gaps driven by questions around the quality and consistency of clinical trial results, patient selection, diagnostic methodologies, use of suppressive antibiotic therapy, and methods for adverse event reporting. We provide specific recommendations for future trial designs of FMT to provide improved quality of the clinical evidence to better inform treatment guidelines.
Oxford University Press