Faecal microbiota transplantation: a review of FMT as an alternative treatment for Clostridium difficile infection

Abstract

Clostridium difficile infection (CDI) is the most common aetiology of hospital acquired infections, the leading cause of nosocomial diarrhoea and a significant clinical and economic burden. Recommended treatment for CDI is prescription of broadspectrum antibiotics. Antibiotic treatment disrupts natural gut microbiota allowing C. difficile to colonize. Clostridium difficile is also resistant to antibiotics and may persist in the gastrointestinal tract for months causing recurrent disease. There is a pressing need for alternate therapies. Faecal microbiota transplantation (FMT) is a promising treatment option whereby healthy donor faecal samples are infused into a patient thus, theoretically, restoring normal bowel conditions. Until recently there has been a paucity of randomized controlled trials and reports of FMT efficacy have been limited to case studies and series. Here, a meta-analysis of 684 patients treated with FMT across 23 independent studies was conducted, reporting a mean resolution rate of 90.4%. Three RCTs are included that, although methodologically limited, appear to verify reports of high efficacy in case reports with minimal adverse effects. FMT appears to be a safe, highly efficacious and affordable treatment option. Future research should focus on potential long-term safety concerns and optimizing protocols for donor screening, patient selection and FMT administration.