Related Evidence

The treatment of recurrent Clostridioides difficile (C. diff.) infection is a subject of increasing interest in the scientific literature.

We have provided links to a sampling of the most important studies related to the use of microbiota-based therapeutics like those under development in our MRT™ drug platform for the prevention of recurrent Clostridium difficile infection, including predecessor therapies.

Randomized Controlled Trial

van Nood E, Vrieze A, Nieuwdorp M, et al. Duodenal infusion of donor feces for recurrent Clostridium difficile. N Engl J Med 2013;368(5):407-415.

Use of Frozen Preparations

Hamilton MJ, Weingarden AR, Unno T, Khoruts A, Sadowsky MJ. High-throughput DNA sequence analysis reveals stable engraftment of gut microbiota following transplantation of previously frozen fecal bacteria. Gut Microbes. 2013;4(2):125-135.

Hamilton MJ, Weingarden AR, Sadowsky MJ, Khoruts A. Standardized frozen preparation for transplantation of fecal microbiota for recurrent Clostridium difficile infection. Am J Gastroenterol 2012;107(5):761-767.

Recent Case Series

Rubin TA, Gessert CE, Aas J, Bakken JS. Fecal microbiome transplantation for recurrent Clostridium difficile infection: Report on a case series. Anaerobe 2013;19:22-26.

Kassam Z, Hundal R, Marshall JK, Lee CH. Fecal transplant via retention enema for refractory or recurrent Clostridium difficile infection. Arch Intern Med 2012;172(2):191-193.

Mattila E, Uusitalo-Seppälä R, Wuorela M, et al. Fecal transplantation, through colonoscopy, is effective therapy for recurrent Clostridium difficile infectionGastroenterology 2012;142(3):490-496.

Mellow MH, Kanatzar A. Colonoscopic fecal bacteriotherapy in the treatment of recurrent Clostridium difficile infection–results and follow-up. J Okla State Med Assoc 2011;104(3):89-91.


Kassam Z, Lee CH, Yuan Y, Hunt RH. Fecal Microbiota Transplantation for Clostridium difficile Infection: Systematic Review and Meta-Analysis. Am J Gastroenterol 2013 Mar 19. doi: 10.1038/ajg.2013.59. [Epub ahead of print]

Gough E, Shaikh H, Manges AR. Systematic review of intestinal microbiota transplantation (fecal bacteriotherapy) for recurrent Clostridium difficile infection. Clin Infect Dis 2011 Nov;53(10):994-1002.

Guo B, Harstall C, Louie T, Veldhuyzen van Zanten S, Dieleman LA. Systematic review: faecal transplantation for the treatment of Clostridium difficile-associated disease. Aliment Pharmacol Ther 2012;35(8):865-875.

Landy J, Al-Hassi HO, McLaughlin SD, Walker AW, et al. Review article: faecal transplantation therapy for gastrointestinal disease. Aliment Pharmacol Ther 2011;34(4):409-415.

van Nood E, Speelman P, Kuijper EJ, Keller JJ. Struggling with recurrent Clostridium difficile infections: is donor faeces the solution? Euro Surveill 2009;14(34). pii: 19316.

Working Groups

Bakken JS, Borody T, Brandt LJ, et al. For the Fecal Microbiota Transplantation Workgroup. Treating Clostridium difficile infection with fecal microbiota transplantation. Clin Gastroenterol Hepatol 2011;9(12):1044-1049.

Allen-Vercoe E, Reid G, Viner N, et al. A Canadian Working Group report on fecal microbial therapy: microbial ecosystems therapeutics. Can J Gastroenterol 2012;26(7):457-462.

Clinical Practice Guidelines

Cohen SH, Gerding DN, Johnson S, et al. for the Society for Healthcare Epidemiology of America; Infectious Diseases Society of America. Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the society for healthcare epidemiology of America (SHEA) and the infectious diseases society of America (IDSA). Infect Control Hosp Epidemiol 2010 May;31(5):431-455.

Bauer MP, Kuijper EJ, van Dissel JT; European Society of Clinical Microbiology and Infectious Diseases. European Society of Clinical Microbiology and Infectious Diseases (ESCMID): treatment guidance document for Clostridium difficile infection (CDI). Clin Microbiol Infect. 2009;15(12):1067-1079.

Epidemiology of Clostridium difficile Infection

Safdar N. Clostridium difficile: the emerging epidemic. Mayo Clin Proc 2012;87(11):1037-1039.

Dubberke E. Clostridium difficile infection: the scope of the problem. J Hosp Med 2012;7 Suppl 3:S1-4.

CDC. Vital signs: preventing Clostridium difficile infections. MMWR 2012; 61(9): 162-167.

Gerding DN. Global epidemiology of Clostridium difficile infection in 2010. Infect Control Hosp Epidemiol 2010; 31 (Suppl 1):S32-S34.

Economics of Clostridium difficile Infection

Elixhauser A, Steiner C, Gould C. Readmissions following Hospitalizations with Clostridium difficile Infections, 2009. Healthcare Cost and Utilization Project Statistical Brief #145. December 2012.

Dubberke E, Olsen. Burden of Clostridium difficile on the healthcare system. Clin Infect Dis 2012; 55 (Suppl 2): S88-S92.

Jones AM, Kuijper EJ, Wilcox MH. Clostridium difficile: a European perspective. J Infect 2013;66(2):115-128.

Lucado J, Gould C, Elixhauser A. Clostridium difficile infections (CDI) in hospital stays, 2009. Healthcare Cost and Utilization Project Statistical Brief #124. January 2012.

Wiegand PN, Nathwani D, Wilcox MH, et al. Clinical and economic burden of Clostridium difficile infection in Europe: a systematic review of healthcare-facility-acquired infection. J Hosp Infect 2012;81(1):1-14.

Antimicrobial Stewardship

Shaughnessy MK, Amundson WH, Kuskowski MA, et al. Unnecessary antimicrobial use in patients with current or recent Clostridium difficile infection. Infect Control Hosp Epidemiol 2013;34(2):109-116.

Harpe SE, Inocencio TJ, Pakyz AL, Oinonen MJ, Polk RE. Characterization of continued antibacterial therapy after diagnosis of hospital-onset Clostridium difficileinfection: implications for antimicrobial stewardship. Pharmacotherapy 2012;32(8):744-754.

Bartlett JG. A call to arms: the imperative for antimicrobial stewardship. Clin Infect Dis 2011;53 Suppl 1:S4-7.