Oral lyophilized fecal microbiota transplantation (FMT) is effective in recurrent Clostridioides difficile infection (CDI); however, limited data exist on its efficacy in primary CDI and long-term microbial engraftment. Patients with primary or recurrent CDI were prospectively enrolled to receive oral FMT. Changes in the bacterial and fungal communities were characterized prior to and up to 6 months following treatment. A total of 37 patients with CDI (15 primary, 22 recurrent) were treated with 6 capsules each containing 0.35-g lyophilized stool extract. A total of 33 patients (89%) had sustained CDI cure, of whom 3 required a second course. There were no safety signals identified. FMT significantly increased bacterial diversity and shifted composition toward donor profiles in responders but not in nonresponders, with robust donor contribution observed to 6 months following FMT (P < 0.001). Responders showed consistent decreases in Enterobacteriaceae and increases in Faecalibacterium sp. to levels seen in donors. Mycobiome profiling revealed an association with FMT failure and increases in one Penicillium taxon, as well as coexclusion relationships between Candida sp. and bacterial taxa enriched in both donors and responders. Primary CDI was associated with more robust changes in the bacterial community than those with recurrent disease. Oral FMT leads to durable microbial engraftment in patients with primary and recurrent CDI, with several microbial taxa being associated with therapy outcome. Novel coexclusion relationships between bacterial and fungal species support the clinical relevance of transkingdom dynamics.

中文翻译：

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艰难梭菌感染中口服冻干粪便微生物群移植后的长期细菌和真菌动力学

口服冻干粪便微生物群移植 (FMT) 对复发性艰难梭菌有效感染（CDI）；然而，关于其在初级 CDI 和长期微生物移植中的功效的数据有限。原发性或复发性 CDI 患者被前瞻性纳入接受口服 FMT。细菌和真菌群落的变化在治疗前和治疗后长达 6 个月进行了表征。总共 37 名 CDI 患者（15 名原发性，22 名复发性）接受了 6 粒胶囊，每粒胶囊含有 0.35 克冻干粪便提取物。共有 33 名患者 (89%) 获得了持续的 CDI 治愈，其中 3 名需要第二个疗程。没有发现安全信号。FMT 显着增加了细菌多样性，并将组成向响应者的供体特征转移，但在无响应者中没有，在 FMT 后 6 个月观察到强大的供体贡献（P< 0.001)。响应者显示肠杆菌科的持续减少和粪杆菌属的增加。达到捐助者的水平。Mycobiome 分析显示与 FMT 失败和一种青霉菌分类群的增加有关，以及念珠菌之间的共排斥关系sp. 和细菌类群在捐赠者和响应者中都富集。与复发性疾病相比，原发性 CDI 与细菌群落中更强烈的变化相关。口服 FMT 导致原发性和复发性 CDI 患者持久的微生物植入，几种微生物分类群与治疗结果相关。细菌和真菌物种之间的新型共排斥关系支持跨界动力学的临床相关性。