Fecal microbiota transplantation may reduce the mortality of patients with severe and fulminant clostridioides difficile infection compared to standard of care antibiotics in a community hospital.

AIM: Clostridioides difficile Infection (CDI) is known for significant morbidity and mortality. Fecal microbiota transplantation (FMT) is an effective therapy for recurrent and resistant CDI. However, its impact on the mortality rate of patients with severe and fulminant CDI has not been rigorously studied yet. We evaluated the effectiveness of FMT on the mortality rate of patients with severe or fulminant CDI in a community hospital system.

METHODS: Our study included 106 inpatients with severe or fulminant CDI. Both standard of care (SOC) and FMT were provided to 14 (13.2%) patients (FMT group). SOC antibiotics alone were provided to 92 (86.8%) patients out of whom we selected 28 controls via propensity score matching (SOC group).

RESULTS: The primary outcome was defined as the composite endpoint of mortality during admission, within 30 and 90 days after discharge, and discharge with comfort measures only. Each component was a secondary endpoint. The primary outcome rate in the FMT group was 7.1% (n=1/14) compared to 25% (n=7/28) in the SOC group. The univariate analysis demonstrated that FMT decreases mortality (odds ratio = 0.08, 95% confidence intervals 0.01 - 0.58, P = 0.01), however multivariate regression did not show statistical significance (odds ratio = 0.15, 95% confidence intervals 0.01 - 2.53, P = 0.19) possibly due to the small sample size.

CONCLUSIONS: FMT may decrease the mortality of patients with severe and fulminant CDI, and larger studies are needed to validate these findings.