S2062 Efficacy of Fecal Microbiota Transplantation in Recurrent Clostridioides difficile Infection (CDI): A Systematic Review

Introduction: Clostridioides difficile infection (CDI) remains a major cause of recurrent diarrhea, with conventional antibiotics often failing to restore gut microbiota balance. Fecal microbiota transplantation (FMT) has shown promise in treating recurrent CDI by replenishing healthy microbial communities. However, variability in FMT protocols necessitates a systematic evaluation of its efficacy and safety. This review assesses FMT’s impact on recurrence rates and adverse outcomes. Methods: A comprehensive search of PubMed, Scopus, and Embase was conducted to retrieve original clinical trials that studied the efficacy of FMT. Outcomes included definite recurrence of CDI, any adverse events, and deaths due to the intervention. Analysis was manually performed from the extracted data. Risk of bias was assessed with ROB 2.0. Results: Out of the 12 studies included in this review, the total sample size was 1,237 patients, of which 778 (62.9%) received FMT, while the remaining participants were assigned to the placebo group. Vancomycin was used in 10 studies (83.3%), either alone or in combination with FMT. It was used alone in 6 studies (50.0%) and in combination with fidaxomicin in 4 studies (33.3%). All studies employed an intention-to-treat analysis. FMT was administered orally in 3 studies (25.0%) and via colonoscopy, enema, or rectal routes in 7 studies (58.3%). The number of donors varied significantly across studies, ranging from a single donor to 32 donors. At least 3 recurrences of CDI were documented in 3 studies (25.0%). Definite recurrence in the FMT group was reported in 16 cases (2.06%), while 9 cases (1.96%) were reported in the placebo group. Abdominal pain was the most common adverse event reported across the studies, with the FMT group showing fewer events compared to the placebo group (85 vs 105 participants), followed by diarrhea. The FMT group had a higher number of diarrhea events compared to the placebo group (95 vs 88 participants). A total of 5 deaths were reported in each of the FMT and placebo groups (0.40% per group). Conclusion: While variations existed in treatment protocols, including routes of administration, antibiotic regimens, and donor selection, the overall findings reinforce the therapeutic potential of FMT in managing recurrent CDI. FMT consistently showed favorable outcomes in terms of symptom resolution and recurrence prevention when compared to placebo.