Predictors and Management of Failed Fecal Microbiota Transplantation for Recurrent Clostridioides difficile Infection

Raseen Tariq, Srishti Saha, DIpesh Solanky, Darrell S. Pardi, Sahil Khanna

Research output: Contribution to journalArticlepeer-review


Background and Goals: Clostridioides difficile infection (CDI) recurs in 10% to 15% after fecal microbiota transplantation (FMT). We identify predictors, and describe management and outcome of patients with recurrent CDI after FMT in a predominantly outpatient cohort. Methods: A nested case-control study of patients undergoing FMT for recurrent CDI from August 2012 to January 2017 was performed. FMT failure was defined as recurrent diarrhea with positive C. difficile stool test during follow-up (≥2 mo). Controls (patients without FMT failures) were matched to cases 1:1 for sex and timing of FMT±1 month. Results: Overall, 522 patients underwent FMT; 70 [13.4%; median age 53.8 years (range, 18 to 89 y), 54.3% females] recurred within a median 5.6 months (range, 0.2 to 34.9 mo). Number of prior CDI episodes, prior CDI treatment, and prior CDI-related hospitalizations were similar in cases and controls. Systemic antibiotics after FMT (54.3% vs. 21.4%, P<0.0001), inflammatory bowel disease (IBD) (34.3% vs. 15.7%, P=0.01), pseudomembranes at FMT (4.3% vs. 0%, P=0.03), and poor bowel preparation (68.5% vs. 31.4%, P=0.01) were associated with FMT failure. On multivariate analysis, IBD [odds ratio (OR) 4.34; 95% confidence interval (CI), 1.24-15.15], systemic antibiotics (OR 7.39; 95% CI, 3.02-18.07), and poor bowel preparation (OR 3.84; 95% CI, 1.59-9.28) predicted FMT failure with an area under the curve of 0.78. Among FMT failures, 37 (52.8%) were managed with antibiotics, 32 (45.7%) with repeat FMT after antibiotics and 1 with colectomy. Conclusions: Use of systemic antibiotics, IBD, and poor bowel preparation predict FMT failure. Patients with FMT failure can be managed with antibiotics and/or repeat FMT.

Original languageEnglish (US)
Pages (from-to)542-547
Number of pages6
JournalJournal of clinical gastroenterology
Issue number6
StatePublished - Jul 2021


  • Clostridioides difficile
  • fecal microbiota transplantation
  • inflammatory bowel disease
  • recurrent C. difficile

ASJC Scopus subject areas

  • Gastroenterology


Dive into the research topics of 'Predictors and Management of Failed Fecal Microbiota Transplantation for Recurrent Clostridioides difficile Infection'. Together they form a unique fingerprint.

Cite this