The Efficacy and Safety of Fecal Microbiota Transplant for Recurrent Clostridiumdifficile Infection: Current Understanding and Gap Analysis
Open Access
- 11 April 2020
- journal article
- review article
- Published by Oxford University Press (OUP) in Open Forum Infectious Diseases
- Vol. 7 (5), ofaa114
- https://doi.org/10.1093/ofid/ofaa114
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.Keywords
This publication has 55 references indexed in Scilit:
- Treg induction by a rationally selected mixture of Clostridia strains from the human microbiotaNature, 2013
- Duodenal Infusion of Donor Feces for RecurrentClostridium difficileThe New England Journal of Medicine, 2013
- Evaluating the Patient With Diarrhea: A Case-Based ApproachMayo Clinic Proceedings, 2012
- Mortality and Clostridium difficile infection: a reviewPublished by Springer Science and Business Media LLC ,2012
- Prolongation of length of stay and Clostridium difficile infection: a review of the methods used to examine length of stay due to healthcare associated infectionsAntimicrobial Resistance & Infection Control, 2012
- Fidaxomicin versus Vancomycin forClostridium difficileInfectionThe New England Journal of Medicine, 2011
- Persistence of Skin Contamination and Environmental Shedding ofClostridium difficileduring and after Treatment of C.difficileInfectionInfection Control & Hospital Epidemiology, 2010
- What is “quality of evidence” and why is it important to clinicians?BMJ, 2008
- Decreased Diversity of the Fecal Microbiome in RecurrentClostridium difficile–Associated DiarrheaThe Journal of Infectious Diseases, 2008