How many recurrences of C. difficile infection warrant a consultation with GI for fecal transplant?

A consultation with a gastroenterologist (GI) for fecal microbiota transplantation is typically considered after a patient has experienced three or more recurrences of Clostridioides difficile infection (CDI). This is supported by guidelines which indicate that after multiple episodes of CDI, particularly when they result in significant morbidity or when conventional treatments fail, fecal transplant can be a viable option. The rationale behind this approach is that fecal transplantation can restore a healthier balance of gut microbiota and significantly reduce the risk of future CDI episodes in patients who have had recurrent infections.

Consultation after fewer than three recurrences might not be warranted because the treatment for CDI often includes antibiotics, and recurrence is common, especially after just one or two episodes. Until the third recurrence, patients are typically managed with standard antibiotic therapies before escalating to more advanced interventions like fecal transplantation. Thus, the established threshold for considering this procedure is three or more recurrences, which reflects the consensus in the medical community regarding optimal management of recurrent CDI.