Fecal microbiota transplant for C. difficile infection: Just say yes.

The burden of Clostridium difficile associated diarrhea is a worrying clinical issue worldwide, mainly as regarding the high incidence of recurrences after standard antibiotic therapy and the risk for more severe clinical manifestations. For this reason, new and more effective therapies are needed for the treatment of recurrent episodes. Fecal microbiota transplantation seems to be a valid tool considering the mechanism of action and the growing number of studies that demonstrate its clinical efficacy.

Cammarota G ，Gallo A ，Bibbò S 《-》

Fecal microbiota transplantation (FMT) for C. difficile infection, just say 'No'.

Despite lack of regulatory approval, fecal microbiota transplantation (FMT) is widely performed to manage C. difficile infection (CDI), particularly recurrent CDI. Herein, we critically review the available randomized controlled trials of FMT and address the following questions: Is FMT better than drug management of recurrent CDI?; Is FMT treatment per se or adjunctive treatment to antibiotics for CDI?; and, Is FMT safe? Finally, we elaborate non-FMT options for the management of recurrent CDI. Although promising, FMT should be reserved for patients who have failed appropriate antibiotic management of recurrent CDI.

Tan X ，Johnson S 《-》

Fecal Microbiota Transplantation in Clostridium difficile Infection: Evidence and Indications.

Shaukat A ，Reinink AR 《-》

Fecal microbiota transplantation in recurrent Clostridium difficile infection in a patient with concomitant inflammatory bowel disease.

Gravito-Soares M ，Gravito-Soares E ，Portela F ，Ferreira M ，Sofia C ... -  《REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS》

Randomised clinical trial: faecal microbiota transplantation by colonoscopy plus vancomycin for the treatment of severe refractory Clostridium difficile infection-single versus multiple infusions.

Faecal microbiota transplantation (FMT) is a highly effective treatment against recurrent Clostridium difficile infection. Far less evidence exists on the efficacy of FMT in treating severe Clostridium difficile infection refractory to antibiotics. To compare the efficacy of two FMT-based protocols associated with vancomycin in curing subjects with severe Clostridium difficile infection refractory to antibiotics. Subjects with severe Clostridium difficile infection refractory to antibiotics were randomly assigned to one of the two following treatment arms: (1) FMT-S, including a single faecal infusion via colonoscopy followed by a 14-day vancomycin course, (2) FMT-M, including multiple faecal infusions plus a 14-day vancomycin course. In the FMT-M group, all subjects received at least two infusions, while those with pseudomembranous colitis underwent further infusions until the disappearance of pseudomembranes. The primary outcome was the cure of refractory severe Clostridium difficile infection. Fifty six subjects, 28 in each treatment arm, were enrolled. Twenty one patients in the FMT-S group and 28 patients in the FMT-M group were cured (75% vs 100%, respectively, both in per protocol and intention-to-treat analyses; P = 0.01). No serious adverse events associated with any of the two treatment protocols were observed. A pseudomembrane-driven FMT protocol consisting of multiple faecal infusions and concomitant vancomycin was significantly more effective than a single faecal transplant followed by vancomycin in curing severe Clostridium difficile infection refractory to antibiotics. Clinical-Trials.gov registration number: NCT03427229.

Ianiro G ，Masucci L ，Quaranta G ，Simonelli C ，Lopetuso LR ，Sanguinetti M ，Gasbarrini A ，Cammarota G ... -  《-》