Washed microbiota transplantation for Clostridioides difficile infection: A national multicenter real‐world study

Xia Wu, Ru Jun Ai, Jie Xu, Quan Wen, Hua Qin Pan, Zhi Hua Zhang, Wang Ning, Ying Fang, Da Fa Ding, Quan Wang, Shuang Han, Xiao Liu, Mei Wu, Zhen Yu Jia, Song Jia, Tao Lin, Bo Ta Cui, Yong Zhan Nie, Xin Wang, Fa Ming Zhang

Fecal microbiota transplantation (FMT) has been recommended for treating recurrent Clostridioides difficile infection (CDI). We aimed to evaluate the efficacy and safety of washed microbiota transplantation (WMT), a new method of FMT, for CDI across various medical settings. This real-world cohort study included CDI patients from multiple centers who underwent WMT. The primary outcome was the clinical cure rate of CDI within 8-week post-WMT. Secondary outcomes included the reduction in total abdominal symptom score (TASS), CDI recurrence rate, and safety during follow-up period. Overall, 90.7% (49/54) of patients achieved clinical cure within 8-week post-WMT. The cure rate for severe and complicated CDI (ScCDI) (n = 30) was 83.3%, and it reached 100% for non-ScCDI (n = 24, p = 0.059). No difference was observed in the clinical cure rate between patients with primary CDI and recurrent CDI (91.89% vs. 88.23%, p = 0.645). One-week post-WMT, the TASS showed a remarkable decrease compared to that before WMT (p < 0.001). 8.16% of patients (4/49) suffered CDI recurrence during follow-up. A WHO performance score of 4, age ≥ 65, higher TASS score, and higher Charlson comorbidity index score (p = 0.018, 0.03, 0.01, 0.034, respectively) were potential risk factors for efficacy. Four transient adverse events related to WMT (3.8%, 4/105) were observed. This study emphasizes the attractive value of WMT for CDI. Early WMT might be a recommendation for CDI, especially for those in serious condition or with complex comorbidities for decreasing deterioration, medical costs, and pain. This article is protected by copyright. All rights reserved.