The presence of Clostridioides difficile in faeces before and after faecal microbiota transplantation and its relation with recurrent C. difficile infection and the gut microbiota in a Dutch cohort

Groenewegen, B.; Lingen, E. van; Kovynev, A.; Berg, A.J. van den; Berssenbrugge, E.K.L.; Sanders, I.M.J.G.; ... ; Netherlands Donor Feces Bank (2025)

Article / Letter to editor

Objectives:

The objectives of this study are to investigate the presence of Clostridioides difficile in faeces of patients with recurrent C. difficile infection (rCDI) before and after faecal microbiota transplantation (FMT) and to identify risk factors for faecal C. difficile and C. difficile infection (CDI) recurrence.

Methods:

n = 83 faecal sample triads (pre-FMT [-1 day], post-FMT [-3 weeks], and a corresponding FMT donor sample), and n = 22 long-term (-1-3 years) follow-up faecal samples were collected from FMTtreated patients. The presence of C. difficile in faeces was assessed by enrichment broth culture and PCR (tcdB gene) and associated with patient characteristics, FMT outcome, duration of pre-FMT vancomycin, FMT donor, post-FMT antibiotic use, and faecal microbiota composition (shotgun metagenomics).

Results:

The FMT cure rate for rCDI was 92.8% (77/83), with six early CDI recurrences (<2 months postFMT). Toxigenic C. difficile was cultured in 27.7% (23/83) of all patients post-FMT, 23.4% (18/77) of patients cured 2 months post-FMT, and 13.6% (3/22) at long-term follow-up. Early CDI recurrence (n = 6) was associated with positive C. difficile culture post-FMT (21.7% [5/23] vs. 1.7% [1/60], p 0.01), post-FMT antibiotics (30.0% [3/10] vs. 4.6% [3/65], p 0.03), and a short course of pre-FMT vancomycin (median 6.0 days, IQR [5-12] vs. 18 days, IQR [10.8-29], p < 0.05). Additionally, positive C. difficile culture directly pre-FMT was associated with a short course of pre-FMT vancomycin (median 9 days IQR [5-18] vs. 17 days, IQR [10-29.2], p 0.04). Gut microbiota analyses did not reveal signatures associated with C. difficile culture result, despite statistically non-significant trends in relative abundances of the Enterobacteriaceae family, and Dorea, Roseburia, and Clostridiales species.

Discussion:

Although eradication of C. difficile is not required for clinical cure of rCDI by FMT, it is associated with reduced prevalence of early CDI recurrence, as are the full completion of pre-FMT vancomycin (at least 10 days) and avoiding post-FMT antibiotics.

Bas Groenewegen, Clin Microbiol (c) 2024 The Authors. Published by Elsevier Ltd on behalf of European Society of Clinical Microbiology and Infectious Diseases. This is an open access article under the CC BY license (http://creativecommons.org/ licenses/by/4.0/).

• Carriage
• Clostridioides difficile
• Colonisation
• Eradication
• Faecal microbiota transplantation
• FMT
• Gut microbiome
• Gut microbiota
• Pre-treatment
• rCDI

• All authors: Groenewegen, B.; Lingen, E. van; Kovynev, A.; Berg, A.J. van den; Berssenbrugge, E.K.L.; Sanders, I.M.J.G.; Prehn, J. van; Nood, E. van; Goorhuis, A.; Kuijper, E.J.; Smits, W.K.; Wiese, M.; Keller, J.J.; Ducarmon, Q.R.; Terveer, E.M.; Netherlands Donor Feces Bank
• Date: 2025-04-01
• Journal: Clinical Microbiology and Infection
• Volume: 31
• Issue: 4
• Pages: 568 - 574
• DOI: doi:10.1016/j.cmi.2024.12.003