Bidirectional application bests other modes of faecal microbiota transfer for rCDI treatment

Same-day bidirectional faecal microbiota transfer (bFMT) seems to be effective against recurrent Clostridioides difficile (rCDI) infections, improving primary cure rates at up to 3 months after the procedure, a recent study has shown.

The researchers conducted a retrospective case-control study using data from 32 bFMT procedures, with combined endoscopic application into the upper and lower gastrointestinal tract. Outcomes were compared to the standard routes of application, each with 32 available samples for analysis: upper (UGIT) and lower (LGIT) gastrointestinal tract, and oral capsules (CAP).

The principal outcome of interest was primary cure, defined as the documented absence of rCDI after a single FMT treatment, assessed 30 and 90 days after the procedure. FMT applied bidirectionally showed the best performance, with 100 percent primary cure rates at both evaluation time points.

In contrast, rCDI recurrence was detected in all other treatment groups. In the LGIT arm, for example, there were six cases of recurrence, yielding a rate of 18.8 percent and a corresponding relative risk (RR) of 0.813 (95 percent confidence interval [CI], 0.688–0.960).

Outcomes were worse in the UGIT and CAP groups, which had 90-day recurrence rates of 40.6 percent (RR, 0.594, 95 percent CI, 0.446–0.791) and 28.1 percent (RR, 0.719, 95 percent CI, 0.579–0.893), respectively.

“[T]he exact mechanisms of action of bFMT still needs to be determined and the substantially higher cure rates require confirmation in a prospective, multicentric setting and larger treatment groups,” the researchers said.

“Nevertheless, the identification of high sustained response rates in combination with an acceptable safety profile in two large case series suggests that bFMT may have the potential to become a superior choice in the treatment of rCDI,” they added.