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. Author manuscript; available in PMC: 2022 Jan 1.
Published in final edited form as: Crit Care Med. 2021 Jan 1;49(1):127–139. doi: 10.1097/CCM.0000000000004739

Table 3.

Summary of comparative studies evaluating fecal microbiota transplant (FMT) for severe or fulminant Clostridioides difficile infection.

Author, year (citation) Country Study design (N) Inclusion criteria Outcome FMT specifics Notes
Hocquart, 2019 (76) France Single center retrospective cohort (N=64) One of WBC ≥15,000/μL, albumin <3 g/dL, Cr >1.47 mg/dL or >1.5x baseline; peritonitis, occlusive syndrome, megacolon, or shock FMT independently associated with mortality reduction (OR 0.08 [95% CI, 0.02–0.34]) Fresh and frozen stool via NGT Did not specify how many patients met each severe criteria
Tixier, 2019 (84) USA Single center matched retrospective cohort (N=48) Severe or fulminant by 2017 IDSA/SHEA criteriaa (47) FMT associated with mortality reduction (OR 0.23 [95% CI 0.06‐0.97]); no difference in colectomy Frozen stool via colonoscopy or flexible sigmoidoscopy Very sick cohort (63% pressors, 65% intubated); groups well matched at baseline
Cheng, 2020 (86) USA Single center retrospective cohort pre-post FMT program (N=430; 199 fulminant, 110 refractory SFCDI) Severe or fulminant by 2017 IDSA/SHEA criteriaa (47); refractory SFCDIb separate FMT program associated with decreased CDI-related mortality and colectomy in all groups Majority frozen-thawed stool via colonoscopy Among fulminant CDI group (mean CCI 5.7), mortality decreased post-FMT (9.1% vs. 21.3%, p=0.02)
a

2017 Infectious Diseases Society of America/Society for Healthcare Epidemiology of America C. difficile guidelines

b

Refractory severe or fulminant CDI defined as severe or fulminant CDI with worsening or no significant improvement in parameters including diarrhea, leukocytosis, hypotension, need for vasopressors after 5 days of maximal CDI therapy.

Abbreviations: CCI=Charlson comorbidity index; CI=confidence interval; Cr=creatinine; FMT=fecal microbiota transplant; N=number of patients included (in fulminant group if multiple groups in study); NGT=nasogastric tube; OR=odds ratio; SFCDI=severe or fulminant refractory Clostridioides difficile infection; USA=United States of America; WBC=white blood cell