In a recent issue of Annals of Internal Medicine, Cammarota et al. showed that the implementation of a fecal microbiota transplantation (FMT) program, available from June 2013 in the A. Gemelli University Hospital, an Italian academic tertiary care centre, led to fewer surgical procedures for severe C. difficile infection (CDI).

Between January 2010 and April 2015, 901 patients with CDI were identified, with a gradual increase over time (2010= 54 patients; 2011= 116 patients; 2012= 200 patients; 2013= 212 patients; 2014= 268 patients; January-April 2015= 71 patients). Thirty-five patients with severe cases underwent FMT: 7 in 2013, 16 in 2014, and 12 between January and April 2015.

Eighteen patients underwent surgery: 1 in 2010, 3 in 2011, 10 in 2012, 4 in 2013, 0 in 2014 and between January and April 2015. Thus, the frequency of surgery decreased after the FMT program was implemented, despite increased hospital admissions of patients with CDI and the continued availability of surgery from the emergency surgery team of the hospital.

Although this retrospective study cannot establish causality, probably the availability of FMT led to the decrease in surgery. If true, FMT programs may be an important way to decrease necessary surgeries at other centres.


Cammarota G, Ianiro G, Magalini S, Gasbarrini A, & Gui D. (2015) Decrease in Surgery for Clostridium difficile Infection After Starting a Program to Transplant Fecal Microbiota. Ann Intern Med. 2015;163(6):487-8.