Introduction

Recurrent Clostridiodes difficile infection (rCDI) is a growing public health burden, and is associated with poor patient outcomes. Fecal microbiota transplantation (FMT) is a novel therapy with an aim to restore the disrupted microbiota with demonstrated success in the management of rCDI and a favorable safety profile.

Areas covered

This review includes a comprehensive overview of a search of the literature including epidemiology of rCDI, basics of the gut microbiome, antibiotic therapy for rCDI along with rationale for safety and efficacy of FMT for rCDI.

Expert opinion

Patients exposed to risk factors, such as antimicrobial agents, are at risk for disruption of the gut microbiome resulting in the reduction of microbial diversity and dysbiosis. Dysbiotic microbiota predispose to primary and rCDI. Strategies to improve the current and future management of rCDI are under clinical investigation, including narrow-spectrum antibiotics, monoclonal antibodies and FMT, which has shown a high success rate for rCDI. Further investigation is needed to determine optimal standardization of the methodological components of FMT including donor screening, stool preparation, storage and instillation and patient follow-up. Newer methods of microbiota replacement therapies including enema- and capsule-based therapies are under investigation.

中文翻译：

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粪便菌群移植治疗复发性艰难梭菌感染的患者。

介绍

艰难梭菌反复感染（rCDI）是日益增加的公共卫生负担，并与患者预后不良相关。粪便微生物群移植（FMT）是一种新颖的疗法，旨在恢复被破坏的微生物群，在rCDI的管理和良好的安全性方面已证明具有成功。

覆盖区域

这篇综述包括对文献的全面概述，包括rCDI的流行病学，肠道微生物组基础知识，rCDI的抗生素治疗以及FMT对rCDI的安全性和有效性的基本原理。

专家意见

暴露于危险因素（例如抗微生物剂）的患者面临肠道微生物组破坏的风险，从而导致微生物多样性降低和营养不良。Dysbiotic微生物群倾向于原发和rCDI。目前正在研究改善rCDI的当前和未来管理的策略，包括窄谱抗生素，单克隆抗体和FMT，这些方法显示出rCDI的成功率很高。为了确定FMT方法学组件的最佳标准化，还需要进一步研究，包括供体筛选，粪便准备，储藏和滴注以及患者随访。微生物群替代疗法的新方法，包括基于灌肠和胶囊的疗法，正在研究中。