• Christine H Lee, Theodore Steiner, Elaine O Petrof, Marek Smieja, Diane Roscoe, Anouf Nematallah, J Scott Weese, Stephen Collins, Paul Moayyedi, Mark Crowther, Mark J Ropeleski, Padman Jayaratne, David Higgins, Yingfu Li, Neil V Rau, and Peter T Kim.
• Hamilton Regional Laboratory Medicine Program, Department of Pathology & Molecular Medicine, McMaster University, Hamilton, Ontario, Canada2Department of Medicine, McMaster University, Hamilton, Ontario, Canada3St Joseph's Healthcare, Hamilton, Ontario, C.
• JAMA. 2016 Jan 12;315(2):142-9.

ImportanceClostridium difficile infection (CDI) is a major burden in health care and community settings. CDI recurrence is of particular concern because of limited treatment options and associated clinical and infection control issues. Fecal microbiota transplantation (FMT) is a promising, but not readily available, intervention.ObjectiveTo determine whether frozen-and-thawed (frozen, experimental) FMT is noninferior to fresh (standard) FMT in terms of clinical efficacy among patients with recurrent or refractory CDI and to assess the safety of both types of FMT.Design, Setting, And ParticipantsRandomized, double-blind, noninferiority trial enrolling 232 adults with recurrent or refractory CDI, conducted between July 2012 and September 2014 at 6 academic medical centers in Canada.InterventionsPatients were randomly allocated to receive frozen (n = 114) or fresh (n = 118) FMT via enema.Main Outcomes And MeasuresThe primary outcome measures were clinical resolution of diarrhea without relapse at 13 weeks and adverse events. Noninferiority margin was set at 15%.ResultsA total of 219 patients (n = 108 in the frozen FMT group and n = 111 in the fresh FMT group) were included in the modified intention-to-treat (mITT) population and 178 (frozen FMT: n = 91, fresh FMT: n = 87) in the per-protocol population. In the per-protocol population, the proportion of patients with clinical resolution was 83.5% for the frozen FMT group and 85.1% for the fresh FMT group (difference, -1.6% [95% CI, -10.5% to ∞]; P = .01 for noninferiority). In the mITT population the clinical resolution was 75.0% for the frozen FMT group and 70.3% for the fresh FMT group (difference, 4.7% [95% CI, -5.2% to ∞]; P < .001 for noninferiority). There were no differences in the proportion of adverse or serious adverse events between the treatment groups.Conclusions And RelevanceAmong adults with recurrent or refractory CDI, the use of frozen compared with fresh FMT did not result in worse proportion of clinical resolution of diarrhea. Given the potential advantages of providing frozen FMT, its use is a reasonable option in this setting.Trial Registrationclinicaltrials.gov Identifier:NCT01398969.

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