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C. difficile — SCE Infectious Diseases MCQ

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ModerateHealthcare-Associated InfectionsC. difficileSCE Infectious Diseases

A 45-year-old woman with recurrent C. difficile infection (3rd episode within 6 months) has failed both oral Vancomycin taper and Fidaxomicin extended-pulse regimen. What is the most appropriate next-line intervention?

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Correct answer: C — Faecal microbiota transplantation (FMT)

FMT is recommended for recurrent CDI (≥2 recurrences) that has failed standard antibiotic therapy. Multiple RCTs demonstrate FMT superiority over repeated antibiotics with cure rates of 80–90% for recurrent CDI. In the UK, FMT is available through regulated stool banks. Bezlotoxumab (anti-toxin B monoclonal antibody) is an adjunct to antibiotics to prevent recurrence but is not a standalone treatment. Metronidazole is no longer appropriate.

Reference: NICE NG199 2021 – C. difficile infection; BSG 2018 – FMT guidelines