P1288 - Efficacy of Fecal Microbiota Transplantation in Recurrent Clostridioides difficile Infection (CDI): A Systematic Review

Muhammad Waqar Elahi, MD¹, Ahmad Khan, ², Azzah Muhammad Hayat, MD², Fahad Rahman, MD², Ibrahim Sayyid, MD¹, Shahryar Khan, MD³, David Shi, MD¹, Eric Huang, MD¹, Vikash Kumar, MD¹, Waqas Ali, MD¹, Arooj Fatima, MD⁴
1West Virginia University School of Medicine, Morgantown, WV; 2Khyber Medical University, Peshawar, North-West Frontier, Pakistan; 3University of Kansas Medical Center, Kansas City, KS; 4Khyber Medical University, Morgantown, WV

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 three 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 five deaths were reported in each of the FMT and placebo groups (0.40% per group).

Discussion: 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.

Disclosures:
Muhammad Waqar Elahi indicated no relevant financial relationships.
Ahmad Khan indicated no relevant financial relationships.
Azzah Muhammad Hayat indicated no relevant financial relationships.
Fahad Rahman indicated no relevant financial relationships.
Ibrahim Sayyid indicated no relevant financial relationships.
Shahryar Khan indicated no relevant financial relationships.
David Shi indicated no relevant financial relationships.
Eric Huang indicated no relevant financial relationships.
Vikash Kumar indicated no relevant financial relationships.
Waqas Ali indicated no relevant financial relationships.
Arooj Fatima indicated no relevant financial relationships.

Muhammad Waqar Elahi, MD¹, Ahmad Khan, ², Azzah Muhammad Hayat, MD², Fahad Rahman, MD², Ibrahim Sayyid, MD¹, Shahryar Khan, MD³, David Shi, MD¹, Eric Huang, MD¹, Vikash Kumar, MD¹, Waqas Ali, MD¹, Arooj Fatima, MD⁴. P1288 - Efficacy of Fecal Microbiota Transplantation in Recurrent <i>Clostridioides difficile</i> Infection (CDI): A Systematic Review, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.