Introduction
Nearly 10% of Clostridium difficile infection (CDI) patients do not respond to fecal microbiota transplantation (FMT) treatment. Conducting clinical FMT studies to reveal microbiome characteristics of FMT-refractory patients is crucial for devising precise treatments for CDI, especially recurrent CDI (rCDI).
Aims & Methods
Twenty-three rCDI patients with parallel clinical baselines were recruited for FMT. Ten FMT donors meeting strict health standards were screened out from thousands of healthy people, and 171 stool samples were collected as healthy controls. Fecal samples were collected from 4 donors continuously for 25 weeks to evaluate the impact of microbiota fluctuation on FMT application.
Results
Seven of 23 patients didn’t respond to FMT treatment. The microbiome characteristics of non-remission patients showed significantly reduced α-diversity indexes. Butyrate-producing bacteria of the Firmicutes, including Bifidobacterium, Christensenellaceae_R_7_group, Ruminococcaceae_unclassified, Veillonella, Coprococcus_2, Fusicatenibacter, Oscillospira, and Roseburia, were almost completely depleted before treatment. Burkholderiales_unclassified, Coprococcus_2, and Oscillospira failed to colonize patient guts before and after treatment. Patients with good prognosis were characterized by a high relative abundance of Veillonella before treatment relative to its general depletion in patients with poor prognosis. Genera interactions in lower effectiveness FMT donors were more similar to those in non-remission patients, and Burkholderiales_unclassified, Coprococcus_2, and Oscillospira were frequently depleted in these donors. Older patients were not conducive to the colonization of Veillonella, consistent with their poor prognosis after FMT. rCDI patients with Crohn's disease were only found in the non-remission group.
Conclusion
rCDI patients with poor prognosis from FMT have characteristics unfavorable to Firmicutes butyrate-producing microbe colonization.
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