Early Fecal Microbiota Transplantation Improves Survival in Severe Clostridium difficile Infections

Background. Severe Clostridium difficile infections (CDIs) are associated with a high mortality rate despite medical and/or surgical treatment. Fecal microbiota transplantation (FMT) prevents recurrences, but its effect on survival has been shown only in patients with O27 ribotype CDI. Here, we investigated whether early FMT could improve survival in hospitalized CDI patients, particularly those with severe infection. Methods. We performed a retrospective cohort study between May 2013 and April 2016 at the infectious diseases department of the North University Hospital of Marseille, France. Patients received either medical treatment alone or treatment with early FMT. The primary outcome was the 3-month mortality rate. Results. A total of 111 patients were included: 66 in the FMT group and 45 in the non-FMT group. No patient underwent surgery. The O27 ribotype (odds ratio [OR], 3.64 [95% confidence interval {CI}, 1.05-12.6], P =.04), severe CDI (OR, 9.62 [95% CI, 2.16-42.8], P =.003), and FMT (OR, 0.13 [95% CI,.04-. 44], P =.001) were independent predictors of 3-month mortality. FMT improved survival in severe cases (OR, 0.08 [95% CI,.016-. 34], P =.001) but not in nonsevere cases (OR, 1.07 [95% CI,.02-56.3], P =.97), independent of age, sex, comorbidities (Charlson score), and ribotype. The number of severe patients who needed to be treated to save 1 life at 3 months was 2. Conclusions. Early FMT dramatically reduces mortality and should be proposed as a first-line treatment for severe CDI. Further studies are needed to clarify complications and contraindications. Surgery should be reassessed in this context.