Introduction: Clostridioides difficile infection (CDI) is a major cause of nosocomial diarrhea related to the use of antimicrobials worldwide. Treatment of recurrent CDI is challenging in countries where fecal microbiota transplantation (FMT) is not widely available. Furthermore, data on the effectiveness and safety of FMT in emerging countries are scarce. Thus, this study aimed to describe the initial experience of the first fecal microbiota transplantation center in Brazil for the treatment of recurrent CDI using frozen samples.

Materials and Methods: FMT was performed via colonoscopy using frozen samples from a stool bank. Donors were screened according to international guidelines and national regulatory resolutions. CDI diagnosis was confirmed in all patients. FMT success was defined as cessation of diarrhea within eight weeks. C. difficile isolates were subjected to ribotyping and antimicrobial susceptibility testing.

Results: Over two years, ten patients with recurrent CDI underwent FMT. The median age was 68 years (range: 23-87 years), 70% were women, 60% had severe infection. Furthermore, a median of 3 previous CDI episodes (range: 1-4) was observed. The primary resolution with a single FMT was 80%, while the overall resolution after the second FMT was 90%. Failure of treatment was not related to CDI severity (p = 0.273), bowel preparation (p = 0.345), comorbidities (p = 0.809), or number of previous episodes (p = 0.457). No serious adverse events were described during the follow-up of 26.6 months (range: 26.6-38.2 months). Mild adverse events occurred in 54.5% of the cases, which was mainly abdominal discomfort on the first day after the procedure. In addition, toxigenic C. difficile isolates belonged to ribotypes 106, 014/020, 131, 076, and 037. All the isolates were susceptible to metronidazole and vancomycin.

Conclusions: FMT is a safe and effective treatment for recurrent CDI in this cohort of Brazilian patients. The implementation of a stool bank allowed for the proper application of all the requirements needed to perform FMT in the country.