Fecal microbiota transplantation for the management of Clostridium difficile infection

Abstract

This article discusses the use of fecal microbiota transplantation (FMT) for the treatment of recurrent Clostridium difficile infection (CDI). The disruption of the normal gut microbiota is central to the pathogenesis of CDI, and disruption persists in recurrent disease. The use of FMT for recurrent CDI is characterized by a high response rate and short term safety is excellent, although the long-term effects of FMT are as yet unknown.

Keywords: Clostridium difficile; Colitis; Fecal microbiota transplantation; Microbiome; Nonantibiotic treatment; Recurrent C difficile infection.

Fig. 1

Pathogenesis of Clostridium difficile infection (CDI). This figure shows how a healthy gut microbiota (upper left corner) is altered by antibiotics to a susceptible state in which either asymptomatic colonization or symptomatic CDI can occur. Some patients do not have recovery of the microbiome back to a healthy state and experience recurrent CDI. Fecal microbiota transplantation can help restore the microbiome to a state resistant to CDI. (Adapted from Britton RA, Young VB. Role of the intestinal microbiota in resistance to colonization by Clostridium difficile. Gastroenterology 2014;146(6):1547–53; with permission.)

Fig. 2

Diversity of the gut microbiome and recurrent Clostridium difficile infection. Rarefaction curve analysis indicates that patients with recurrent infection have lower diversity of their gut microbiome compared with healthy controls or patients with a successfully treated initial infection. (Adapted from Chang JY, Antonopoulos DA, Kalra A, et al. Decreased diversity of the fecal microbiome in recurrent Clostridium difficile–associated diarrhea. J Infect Dis 2008;197(3):435–8; with permission.)

Fig. 3

Composition of the gut microbiome after stool transplant. The microbial composition of the patient’s stool after transplant is similar to the donor’s stool and is more diverse than before transplant. (Adapted from Seekatz AM, Aas J, Gessert CE, et al. Recovery of the gut microbiome following fecal microbiota transplantation. mBio 2014;5(3):e00893–914; with permission.)