Fecal Microbiota Transplantation (FMT) in Clostridium difficile Infection: A Paradigm Shift in Gastrointestinal Microbiome Modulation

Abstract

Clostridium difficile (C. difficile​​​​​​) infection (CDI) poses a tremendous clinical challenge, especially in patients with recurrent disease and antibiotic resistance. Fecal microbiota transplantation (FMT) has become a new therapeutic strategy for restoring gut microbiota and decreasing CDI recurrence. The study aims to assess the clinical effectiveness of FMT in adult subjects with recurrent or refractory CDI, determine its effect on gut microbiome diversity, and track safety outcomes and rates of recurrence post-treatment. FMT was compared against standard antibiotic treatments to establish its efficacy in decreasing infection persistence and improving patients' quality of life. This study examines the efficacy, safety, and modulation of microbiota by FMT in an ensemble of 250 patients diagnosed with CDI, with equal gender distribution and a mean age of 55.61. Among the study participants, 131 (52.4%) underwent FMT by various routes of administration, including 66 (25.2%) through colonoscopy, 73 (29.2%) via a nasogastric tube, 60 (24.0%) via enema, and 54 (21.6%) through oral capsule administration. The success rate for FMT was reported as 88 (35.2%), partial success at 74 (29.6%), and treatment failure at 88 (35.2%). CDI recurrence was reported in 130 (52.0%) of patients after FMT. The gut microbiome enhanced diversity, measured in terms of the Shannon Diversity Index, increased significantly from 3.96 before FMT to 5.88 after FMT, thus indicating a favorable impact on gut microbial composition. Furthermore, 132 (52.8%) converted from C. difficile polymerase chain reaction (PCR) toxin positive to negative, corroborating successful pathogen clearance. On secondary outcomes, the quality of life in patients improved in 90 (36%), antibiotic dependence was reduced in 88 (35.2%), and hospitalization was lessened in 72 (28.8%). Inflammatory markers, such as white blood cell (WBC) counts and C-reactive protein (CRP), went downward but did not reach statistical significance. Logistic regression analysis identified age, severity of CDI, and prior exposure to antibiotics as the main predictors for the efficacy of FMT (p < 0.05). It is concluded that FMT is a promising alternative treatment for recurrent CDI through modulation of gut microbiota and decreasing the severity of infection. Future work is, however, required to establish treatment protocols with optimized results for long-term effectiveness and minimized recurrence risks.

Keywords: clostridium difficile infection; fecal microbiota transplantation; gut microbiome; microbiome diversity; recurrent cdi.

Figure 1. This histogram represents the age distribution of patients, showing the number of patients across different age groups. The age range spans from approximately 18 to 90 years, with the highest concentration of patients between 60 and 90 years. The most frequent age group has over 30 patients, while other age groups have a relatively even distribution. The histogram suggests that older patients are more prevalent in the dataset

Figure 2. This bar chart represents the distribution of initial treatment types for patients. The highest percentage of patients received fecal microbiota transplant (FMT), with over 50%, while around 45% did not receive FMT. Among antibiotic treatments, fidaxomicin was the most commonly used (~30%), followed by metronidazole (~27%), vancomycin (~22%), and no treatment (~21%). This distribution highlights the prominence of FMT as a treatment option in this patient population

Figure 3. Distribution of FMT outcomes among patients with Clostridium difficile infection: complete success (35.2%), partial success (29.6%), and treatment failure (35.2%), illustrating the variability in patient response to FMT and the need for treatment optimization

Figure 4. This bar chart presents the primary and secondary outcomes of treatment. The resolution of infection was observed in ~34% of patients, while CDI recurrence occurred in ~30%. Persistent infection was seen in ~37% of cases. Among secondary outcomes, reduced hospitalization (~28%), fewer antibiotic needs (~36%), and improved quality of life (~37%) were reported. These results highlight the impact of treatment on infection resolution, recurrence, and patient well-being

CDI: Clostridium difficile infection

Figure 5. The box plot represents the distribution of hospital stay duration, with the interquartile range (IQR) between 10 and 25 days. The median hospital stay is 16 days, while the minimum and maximum durations are three and 30 days, respectively. The whiskers extend within 1.5 times the IQR, indicating the typical range of hospital stays