Exploring the Latest Update to the C difficile Guidelines

Dale N Gerding, MD, research physician at Edward Hines Jr. Veterans Administration Hospital, discusses the most recent changes to the guidelines of C difficile and the concerns of long-term effects of fecal microbiome transplants.

Interview transcript (modified slightly for readability):

“The major changes to the guidelines [of Clostridium difficile], I believe are, first of all, that they now include specific recommendations for pediatric patients, which previously have not been included. Secondly, the guidelines now use what’s called grade evaluation for the recommendations and the quality of the evidence behind the recommendations. And the 2 major clinical differences from previous guidelines, I believe, are in how diagnosis should be [made] in hospitals and the elimination of metronidazole as a first line therapy for C difficile infection.

For multiply recurrent C difficile, the guidelines now include fecal microbiome transplant (FMT) as an option. It’s recommended that it be reserved for patients who have had at least 2 recurrences, and are now having their third episode of C difficile.

The utilization of FMT is new; it’s not approved by the US Food and Drug Administration at this time. It is very important that the donors of those stool specimens [are] properly screened for multiple infections that can be transmitted.

Perhaps one of the things that we’re most concerned about is the long-term effect of the fecal transplant in the event that we alter something in the microbiome that could lead to other potential diseases that we don’t know about right now.”