Date of Award

2024

Document Type

Dissertation

Degree Name

Doctor of Medical Science (DMSc)

Department

Department of Physician Assistant Medicine

First Advisor

Alli Guerrero

Second Advisor

Michelle Rhea

Third Advisor

Heather Justice

Abstract

Clostridium difficile is a gram-positive, spore-forming anaerobic bacterium that causes a spectrum of clinical presentations from mild diarrhea to severe colitis. Clostridium difficile infection (CDI) remains a persistent challenge with a notable burden of recurrence in a subset of 1 patients. Recurrent CDI is associated with increased healthcare costs, heightened risk of complications and elevated mortality rates. While standard antibiotic therapies can be effective initially, they often fail to provide sustained clinical remission, making alternative treatment

1 options such as fecal microbiota transplantation (FMT) necessary. Biotherapeutics is another alternative with less risks of resistance than with antibiotic therapy. Efforts to develop targeted therapeutics have increased, addressing the root cause of CDI while minimizing the risk of recurrence. Despite uncertainties regarding the long-term implications of FMT, expanding treatment options for CDI is beneficial for improving treatment success and patient outcomes.

Each individual’s gut microbiota can largely vary based on location within the

2 gastrointestinal tract, diet, and individual differences; however, their function remains the same.

FMT was introduced in the United States in the 20th century. The therapy is thought to restore the balance of gut microbiota by outcompeting Clostridium difficile and promoting bile-salt metabolism to inhibit spore germination. Although these mechanisms have been researched, other potential mechanisms could contribute to FMT’s effectiveness in treating recurrent CDI that remain under investigation.

Antibiotic therapies has been a primary This paper aims to analyze the comparative effectiveness of FMT versus standard antibiotic therapy in achieving higher rates of sustained clinical remission and preventing recurrence in adults with recurrent CDI. By utilizing the PICO question format- Population, Intervention, Comparison, and Outcome- we can address this question. In adults, 19 years and older, diagnosed with recurrent Clostridium difficile infection, does treatment with fecal microbiota transplantation (FMT) compared to standard antibiotic therapy result in higher rates of sustained clinical remission and prevention of recurrence?

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