Study finds fecal transplants more effective than antibiotics in treating recurrent, life-threatening intestinal infections
A new Cochrane review found that compared to standard antibiotic treatment, fecal transplant can increase the number of people who recover from Clostridioides difficile (C. diff) infection from 40% to 77%.
The Cochrane review led by an Upstate Medical University professor found that, compared with standard antibiotic treatment, stool transplant may increase the number of people who recover from Clostridioides difficile (C. diff) infection, a condition which causes life-threatening diarrhea. 77 percent of people who received a stool transplant did not experience reinfection within eight weeks, compared to 40 percent of those who received antibiotics alone.
C. diff is a bacteria that can cause a life-threatening diarrheal illness in people with an unhealthy mix of gut bacteria, known as dysbiosis . The most common cause of dysbiosis is antibiotic treatment , and while antibiotics can be very effective against bacterial infections, they can also harm the beneficial bacteria that colonize the gut, known as the gut microbiome. Typically, this ecosystem of "good" bacteria recovers quickly, but occasionally "bad" species like C. diff take over and cause severe diarrhea.
Standard treatment for C. diff infection includes antibiotics, which can further exacerbate dysbiosis. This can lead to a vicious cycle of short-term treatment effect followed by recurrent infection. This happens in almost a third of infected people. According to the CDC, there are about a quarter of a million C. diff infections each year in the U.S. alone, resulting in approximately 12,000 deaths.
Transplanting feces from healthy donors into a dysbiotic gut aims to balance gut microbes and reestablish a healthy microbiome, significantly reducing the risk of C. diff recurrence. Donating stool works the same way as donating blood. Donors are screened for diseases and infections before they can donate their stool. Stool can be transplanted by colonoscopy, nasogastric or nasoduodenal tube, enema, or via a capsule. The U.S. Food and Drug Administration recently approved a stool transplant product for the prevention of C. diff recurrence that can be administered as an enema.
The new Cochrane review, led by pediatric gastroenterologist Aamer Imdad MBBS, examined data from six clinical trials involving a total of 320 adults that evaluated the effectiveness and safety of stool transplantation for the treatment of repeat C. diff infections. Two studies were conducted in Denmark and one each in the Netherlands, Italy, Canada, and the United States. Most of the included studies compared stool transplantation with standard antibiotic treatment with vancomycin , which is commonly used for this type of infection.
The review found that stool transplantation leads to a greater increase in resolution of repeat C. diff infections than other treatments studied, as well as a decrease in side effects compared to standard antibiotic treatment.
“After a person with a C. diff infection is treated with antibiotics, there is a 25 percent chance that they will have another episode of C. diff infection in the next 8 weeks,” Imdad said. “The risk of recurrence increases to about 40 percent with the second episode and almost 60 percent with the third episode. So once you are in this cycle, it becomes increasingly difficult to get out of it. “Stool transplants can reverse dysbiosis and therefore decrease the risk of disease recurrence.”
A second Cochrane review, also led by Dr. Imdad, looks at the use of stool transplants for the treatment of inflammatory bowel disease (IBD), a term primarily used to describe two conditions: ulcerative colitis and ulcerative colitis. Crohn’s . Review shows promising results for ulcerative colitis; however, the data is still inconclusive. The results for Crohn’s disease are even less conclusive. More research will be required before stool transplants can be considered for the treatment of IBD.
Implications for practice In immunocompetent adults with recurrent Clostridioides difficile infection (rCDI), fecal microbiota transplantation (FMT) likely leads to a large increase in resolution of rCDI compared to alternative treatments such as antibiotics. Fecal microbiota transplantation likely results in a small decrease in rates of serious adverse events and may decrease all-cause mortality in patients with rICD; however, the number of events was small and an increased risk for these outcomes cannot be ruled out. Additional data from large national registry databases may be required to evaluate potential short- and long-term risks with the use of FMT for the treatment of rCDI in clinical practice. Based on the low number of immunocompromised participants recruited in the included studies, no conclusions can be drawn regarding the beneficial or harmful effects of FMT for rCDI in the immunocompromised population at this time. |
Imdad collaborated with doctors from across the country on both studies, including Norton School of Medicine graduate Nathan Zev Minkoff, upstate students Natasha Pandit and Muiz Zaman, Class of 2023 at Norton School of Medicine, and Melissa Medina, Class of 2026 in the Department of Public Health and Preventive Medicine, on the C-diff study. The other collaborators included Dr. Maribeth Nicholson and Dr. Sari Acra of Vanderbilt University Medical Center, Dr. Scheherzade Asalam of the University of Nebraska, Dr. Emily E Tanner Smith of the University of Oregon, the Dr. Oscar Gómez of the University at Buffalo and Dr. Joseph Zackular of the University of Pennsylvania.
