Review
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World J Gastroenterol. Jun 21, 2014; 20(23): 7416-7423
Published online Jun 21, 2014. doi: 10.3748/wjg.v20.i23.7416
Recurrent Clostridium difficile infections: The importance of the intestinal microbiota
Marie Céline Zanella Terrier, Martine Louis Simonet, Philippe Bichard, Jean Louis Frossard
Marie Céline Zanella Terrier, Martine Louis Simonet, Service of General Internal Medicine, Geneva University Hospital, 1211 Geneva, Switzerland
Philippe Bichard, Jean Louis Frossard, Service of Gastroenterology and Hepatology, Geneva University Hospital, 1211 Geneva, Switzerland
Author contributions: Zanella Terrier MC, Simonet ML, Bichard P and Frossard JL performed the research; Zanella Terrier MC, Frossard JL wrote the paper; Zanella Terrier MC, Simonet ML and Bichard P analyzed the data.
Correspondence to: Jean Louis Frossard, MD, Service of Gastroenterology and Hepatology, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva, Switzerland. jean-louis.frossard@hcuge.ch
Telephone: +41-22-3729340 Fax: +41-22-3729366
Received: September 25, 2013
Revised: January 28, 2014
Accepted: April 21, 2014
Published online: June 21, 2014
Processing time: 269 Days and 1.2 Hours
Abstract

Clostridium difficile infections (CDI) are a leading cause of antibiotic-associated and nosocomial diarrhea. Despite effective antibiotic treatments, recurrent infections are common. With the recent emergence of hypervirulent isolates of C. difficile, CDI is a growing epidemic with higher rates of recurrence, increasing severity and mortality. Fecal microbiota transplantation (FMT) is an alternative treatment for recurrent CDI. A better understanding of intestinal microbiota and its role in CDI has opened the door to this promising therapeutic approach. FMT is thought to resolve dysbiosis by restoring gut microbiota diversity thereby breaking the cycle of recurrent CDI. Since the first reported use of FMT for recurrent CDI in 1958, systematic reviews of case series and case report have shown its effectiveness with high resolution rates compared to standard antibiotic treatment. This article focuses on current guidelines for CDI treatment, the role of intestinal microbiota in CDI recurrence and current evidence about FMT efficacy, adverse effects and acceptability.

Keywords: Clostridium difficile infection; Clostridium difficile recurrence; Fecal microbiota transplantation; Stool transplantation; Microbiota

Core tip: Despite current antibiotic treatments, Clostridium difficile infection (CDI) is a growing epidemic with increasing rates of recurrence, severity and mortality. The treatment of recurrent CDI thus represents a real challenge. This article simultaneously focuses on current guidelines for CDI treatment, the role of gut microbiota in CDI recurrence and current evidence about fecal microbiota transplantation (FMT) efficacy, adverse effects and acceptability. According to studies published to date, FMT use for recurrent CDI is associated with high resolution rates compared with standard antibiotic treatment. Further studies are needed to confirm FMT effectiveness, and to determine the long-term consequences and good administration practices.