FMT for Severe C. difficile Infection: If at First You Do No Harm, the Second Time’s a Charm

Excerpt

Over the past 10 years, there has been a substantial increase in the use of fecal microbiota transplantation (FMT) to treat recurrent Clostridioides difficile infection (CDI) after failed antibiotic therapy. Most medical societies across the world have incorporated FMT into their guidelines in recognition of the effectiveness of this treatment for recurrent CDI. The global cure rate of CDI after FMT is reported to be between 80 and 90%. The clinical quandary is what to do with the 10–20% of patients that fail a first FMT. While there have been several studies exploring the risk factors for FMT failure such as severe/fulminant infection, inpatient status at time of FMT, and multiple CDI-related hospitalizations, there are no clear guidelines on how to proceed after a patient fails an initial FMT [1, 2]. …