{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T19:08:03Z","timestamp":1793387283029,"version":"4.5.0"},"reference-count":26,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:00:00Z","timestamp":1792108800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:00:00Z","timestamp":1792108800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Aliment Pharmacol Ther"],"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n \n Faecal microbiota transplant (FMT) is an effective treatment for multiply recurrent\n \n C. difficile<\/jats:italic>\n <\/jats:styled-content>\n infection (mrCDI). Less is known about rates of reinfection after successful FMT. We aimed to estimate the incidence of CDI reinfection, 6 or more months after FMT, to determine whether rates differ between mrCDI treated with and without FMT and whether proton pump inhibitor (PPI) therapy increases the risk of reinfection.\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Among patients with mrCDI (defined as \u2265\u20092 recurrences after the initial CDI episode) we compared reinfection with CDI (defined as a first recurrence >\u2009183\u2009days after treatment completion) in patients who underwent antibiotics followed by FMT with those treated with antibiotics alone in Optum's de\u2010identified Clinformatics Data Mart Database (OPTUM CDM). We also compared reinfection between those with and without PPI use in OPTUM CDM and the American Gastroenterological Association FMT Registry.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n In OPTUM CDM, 6384 patients treated with antibiotics alone and 1786 with antibiotics + FMT met inclusion criteria (median follow\u2010up 704\u2009days). One\u2010year and 3\u2010year CDI reinfection incidences were 5% and 10% in the FMT group and 6% and 12% in the antibiotics group: Cox regression HR 0.89, 95% CI 0.73\u20131.08. PPI use was associated with an increased risk of reinfection following FMT (HR 1.57, 1.03\u20132.41) in OPTUM CDM and in the FMT Registry (HR 1.62, 95% CI 0.84\u20133.12).<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n CDI reinfection rates are low after successful FMT and similar to rates in patients treated with antibiotics alone. PPI use was associated with reinfection, supporting reassessment of the ongoing indication for PPI therapy in patients with mrCDI.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/apt.71035","type":"journal-article","created":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T04:36:01Z","timestamp":1792211761000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Incidence and Risk Factors for\n \n C. difficile<\/i>\n <\/scp>\n Reinfection After Faecal Microbiota Transplantation or Antibiotic Therapy"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-8176-2393","authenticated-orcid":false,"given":"C. R.","family":"Kelly","sequence":"first","affiliation":[{"name":"Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine Brigham and Women's Hospital, Harvard Medical School Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B. J.","family":"Kelly","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases Perelman School of Medicine, University of Pennsylvania Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-6732-5322","authenticated-orcid":false,"given":"Q.","family":"Wu","sequence":"additional","affiliation":[{"name":"Center for Clinical Epidemiology and Biostatistics University of Pennsylvania Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4296-7901","authenticated-orcid":false,"given":"L.","family":"Laine","sequence":"additional","affiliation":[{"name":"Yale School of Medicine New Haven Connecticut USA"},{"name":"VA Connecticut Healthcare System West Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G. D.","family":"Wu","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology Perelman School of Medicine, University of Pennsylvania Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Kim","sequence":"additional","affiliation":[{"name":"American Gastroenterological Association Bethesda Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Fredell","sequence":"additional","affiliation":[{"name":"American Gastroenterological Association Bethesda Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Serra","sequence":"additional","affiliation":[{"name":"American Gastroenterological Association Bethesda Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3107-3862","authenticated-orcid":false,"given":"J. D.","family":"Lewis","sequence":"additional","affiliation":[{"name":"Center for Clinical Epidemiology and Biostatistics University of Pennsylvania Philadelphia Pennsylvania USA"},{"name":"Division of Gastroenterology and Hepatology Perelman School of Medicine, University of Pennsylvania Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,16]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"crossref","DOI":"10.1186\/s12879-023-08096-0","article-title":"The Burden of CDI in The United States: A Multifactorial Challenge","volume":"23","author":"Feuerstadt P.","year":"2023","journal-title":"BMC Infectious Diseases"},{"key":"e_1_2_9_3_1","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1093\/cid\/ciy149","article-title":"Clinical Practice Guidelines for \n Clostridium difficile\n Infection in Adults and Children: 2017 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA)","volume":"66","author":"McDonald L. C.","year":"2018","journal-title":"Clinical Infectious Diseases"},{"key":"e_1_2_9_4_1","doi-asserted-by":"crossref","first-page":"1721","DOI":"10.1016\/j.jamda.2022.01.075","article-title":"Mortality, Health Care Use, and Costs of Clostridioides Difficile<\/Em> Infections in Older Adults","volume":"23","author":"Feuerstadt P.","year":"2022","journal-title":"Journal of the American Medical Directors Association"},{"key":"e_1_2_9_5_1","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1017\/ice.2016.246","article-title":"A Comprehensive Study of Costs Associated With Recurrent \n Clostridium difficile\n Infection","volume":"38","author":"Rodrigues R.","year":"2017","journal-title":"Infection Control and Hospital Epidemiology"},{"key":"e_1_2_9_6_1","doi-asserted-by":"crossref","first-page":"152","DOI":"10.7326\/M16-2733","article-title":"Increasing Incidence of Multiply Recurrent \n Clostridium difficile\n Infection in the United States: A Cohort Study","volume":"167","author":"Ma G. K.","year":"2017","journal-title":"Annals of Internal Medicine"},{"key":"e_1_2_9_7_1","doi-asserted-by":"crossref","first-page":"1124","DOI":"10.14309\/ajg.0000000000001278","article-title":"ACG Clinical Guidelines: Prevention, Diagnosis, and Treatment of Clostridioides Difficile Infections","volume":"116","author":"Kelly C. R.","year":"2021","journal-title":"American Journal of Gastroenterology"},{"key":"e_1_2_9_8_1","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1146\/annurev-micro-091014-104115","article-title":"Interactions Between the Gastrointestinal Microbiome and \n Clostridium difficile","volume":"69","author":"Theriot C. M.","year":"2015","journal-title":"Annual Review of Microbiology"},{"key":"e_1_2_9_9_1","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1086\/501553","article-title":"Recurrent \n Clostridium difficile\n Disease: Epidemiology and Clinical Characteristics","volume":"20","author":"McFarland L. 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W.","year":"2012","journal-title":"Clinical Infectious Diseases"},{"key":"e_1_2_9_12_1","doi-asserted-by":"crossref","first-page":"2386","DOI":"10.1128\/JCM.38.6.2386-2388.2000","article-title":"Epidemiology of Recurrences or Reinfections of \n Clostridium difficile\n \u2010Associated Diarrhea","volume":"38","author":"Barbut F.","year":"2000","journal-title":"Journal of Clinical Microbiology"},{"key":"e_1_2_9_13_1","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1056\/NEJMoa2106516","article-title":"SER\u2010109, an Oral Microbiome Therapy for Recurrent Clostridioides Difficile Infection","volume":"386","author":"Feuerstadt P.","year":"2022","journal-title":"New England Journal of Medicine"},{"key":"e_1_2_9_14_1","doi-asserted-by":"crossref","first-page":"609","DOI":"10.7326\/M16-0271","article-title":"Effect of Fecal Microbiota Transplantation on Recurrence in Multiply Recurrent \n Clostridium difficile\n Infection: A Randomized Trial","volume":"165","author":"Kelly C. R.","year":"2016","journal-title":"Annals of Internal Medicine"},{"key":"e_1_2_9_15_1","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1053\/j.gastro.2020.09.038","article-title":"Fecal Microbiota Transplantation Is Highly Effective in Real\u2010World Practice: Initial Results From the FMT National Registry","volume":"160","author":"Kelly C. R.","year":"2021","journal-title":"Gastroenterology"},{"key":"e_1_2_9_16_1","doi-asserted-by":"crossref","first-page":"1705","DOI":"10.1093\/cid\/cix1097","article-title":"Durability and Long\u2010Term Clinical Outcomes of Fecal Microbiota Transplant Treatment in Patients With Recurrent \n Clostridium difficile\n Infection","volume":"66","author":"Mamo Y.","year":"2018","journal-title":"Clinical Infectious Diseases"},{"key":"e_1_2_9_17_1","doi-asserted-by":"crossref","first-page":"e1706","DOI":"10.1093\/cid\/ciaa1457","article-title":"Durability of Response to Fecal Microbiota Transplantation After Exposure to Risk Factors for Recurrence in Patients With Clostridioides Difficile Infection","volume":"73","author":"Saha S.","year":"2020","journal-title":"Clinical Infectious Diseases"},{"key":"e_1_2_9_18_1","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1016\/j.jinf.2009.03.010","article-title":"Recurrent \n Clostridium difficile\n Infection: A Review of Risk Factors, Treatments, and Outcomes","volume":"58","author":"Johnson S.","year":"2009","journal-title":"Journal of Infection"},{"key":"e_1_2_9_19_1","doi-asserted-by":"crossref","first-page":"1913","DOI":"10.1038\/s41591-022-01964-3","article-title":"Variability of Strain Engraftment and Predictability of Microbiome Composition After Fecal Microbiota Transplantation Across Different Diseases","volume":"28","author":"Ianiro G.","year":"2022","journal-title":"Nature Medicine"},{"key":"e_1_2_9_20_1","doi-asserted-by":"crossref","DOI":"10.24926\/iip.v12i1.3439","article-title":"The Positive Association Between Proton Pump Inhibitors and \n Clostridium difficile\n Infection","volume":"12","author":"Tawam D.","year":"2021","journal-title":"Innov Pharm"},{"key":"e_1_2_9_21_1","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1053\/j.gastro.2017.01.028","article-title":"The AGA's Fecal Microbiota Transplantation National Registry: An Important Step Toward Understanding Risks and Benefits of Microbiota Therapeutics","volume":"152","author":"Kelly C. 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K.","year":"2020","journal-title":"Journal of Clinical Gastroenterology"},{"key":"e_1_2_9_24_1","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1038\/s41586-025-08937-9","article-title":"Diet Outperforms Microbial Transplant to Drive Microbiome Recovery in Mice","volume":"642","author":"Kennedy M. S.","year":"2025","journal-title":"Nature"},{"key":"e_1_2_9_25_1","doi-asserted-by":"crossref","first-page":"970","DOI":"10.1053\/j.gastro.2025.04.027","article-title":"Dietary Fiber Modulates the Window of Susceptibility to Clostridioides Difficile Infection","volume":"169","author":"Hewlett K. K.","year":"2025","journal-title":"Gastroenterology"},{"key":"e_1_2_9_26_1","doi-asserted-by":"crossref","first-page":"772","DOI":"10.1001\/archinternmed.2010.73","article-title":"Proton Pump Inhibitors and Risk for Recurrent \n Clostridium difficile\n Infection","volume":"170","author":"Linsky A.","year":"2010","journal-title":"Archives of Internal Medicine"},{"key":"e_1_2_9_27_1","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1001\/jamainternmed.2015.42","article-title":"Continuous Proton Pump Inhibitor Therapy and the Associated Risk of Recurrent \n Clostridium difficile\n Infection","volume":"175","author":"McDonald E. G.","year":"2015","journal-title":"JAMA Internal Medicine"}],"container-title":["Alimentary Pharmacology & Therapeutics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/apt.71035","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/apt.71035","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/apt.71035","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T04:36:09Z","timestamp":1792211769000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/apt.71035"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,16]]},"references-count":26,"alternative-id":["10.1111\/apt.71035"],"URL":"https:\/\/doi.org\/10.1111\/apt.71035","archive":["Portico"],"relation":{},"ISSN":["0269-2813","1365-2036"],"issn-type":[{"value":"0269-2813","type":"print"},{"value":"1365-2036","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,16]]},"assertion":[{"value":"2026-05-09","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-29","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-16","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"apt.71035"}}