Faecal Microbiota Transplantation for Recurrent Clostridioides difficile Infection: Implementation, Delivery Routes and Sustained Cure Across One Hundred and Eighty Six Procedures

Dr. Sanjeev Dimri, Mohd. Khursheed, Shilki Sharma

Faecal Microbiota Transplantation; Clostridioides Difficile; Recurrent CDI; Gut Microbiome; Vancomycin; Colonoscopy.

Recurrent Clostridioides difficile infection (CDI) is increasingly common, particularly in patients exposed to repeated antibiotic courses, and responds poorly to escalating courses of vancomycin or fidaxomicin. Faecal microbiota transplantation (FMT) restores gut microbial diversity and has become the standard of care for recurrent CDI in international guidelines. We implemented an FMT programme at a tertiary gastroenterology service and prospectively followed 186 patients receiving FMT for recurrent CDI over 12 months, with historical comparisons to vancomycin-tapering controls (n=98). Clinical cure at 8 weeks was achieved by 158 patients (84.9%) after a single FMT procedure and by 168 (90.3%) after up to two FMT procedures. Sustained cure at 12 months was 76.3% in the FMT cohort, compared with 42.9% in the historical vancomycin-tapering cohort. Colonoscopy delivery achieved modestly higher cure rates than nasoduodenal or oral-capsule delivery. Stronger predictors of cure included colonoscopy route and adequate pre-FMT vancomycin pre-treatment; concurrent broad-spectrum antibiotics, severe CDI at procedure, and inflammatory bowel disease comorbidity reduced cure probability. The findings support FMT as a high-cure-rate intervention with sustained 12-month benefit across multiple delivery routes.

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