Published online Jun 21, 2014. doi: 10.3748/wjg.v20.i23.7416
Revised: January 28, 2014
Accepted: April 21, 2014
Published online: June 21, 2014
Clostridium difficile infections (CDI) are a leading cause of antibiotic-associated and nosocomial diarrhea. Despite effective antibiotic treatments, recurrent infections are common. With the recent emergence of hypervirulent isolates of C. difficile, CDI is a growing epidemic with higher rates of recurrence, increasing severity and mortality. Fecal microbiota transplantation (FMT) is an alternative treatment for recurrent CDI. A better understanding of intestinal microbiota and its role in CDI has opened the door to this promising therapeutic approach. FMT is thought to resolve dysbiosis by restoring gut microbiota diversity thereby breaking the cycle of recurrent CDI. Since the first reported use of FMT for recurrent CDI in 1958, systematic reviews of case series and case report have shown its effectiveness with high resolution rates compared to standard antibiotic treatment. This article focuses on current guidelines for CDI treatment, the role of intestinal microbiota in CDI recurrence and current evidence about FMT efficacy, adverse effects and acceptability.
Core tip: Despite current antibiotic treatments, Clostridium difficile infection (CDI) is a growing epidemic with increasing rates of recurrence, severity and mortality. The treatment of recurrent CDI thus represents a real challenge. This article simultaneously focuses on current guidelines for CDI treatment, the role of gut microbiota in CDI recurrence and current evidence about fecal microbiota transplantation (FMT) efficacy, adverse effects and acceptability. According to studies published to date, FMT use for recurrent CDI is associated with high resolution rates compared with standard antibiotic treatment. Further studies are needed to confirm FMT effectiveness, and to determine the long-term consequences and good administration practices.