Faecal transplant blocks UTI return

Faecal microbiota transplantation (FMT) has been shown to help resolve recurrent urinary tract infections in a small study.

In a cohort of 11 patients (average age 70 years, nine female) who were experiencing two UTI episodes within 6 months or three episodes within 1 year and underwent FMT for recurrent C difficile colitis, the transplant successfully stopped UTI recurrence. The number of UTI episodes dropped from 3.7 in 2 years prior to FMT to 0.27 over the 2-year follow-up (p=0.001). [Urology 2025:204:69-75]

Specifically, eight patients were UTI-free during the follow-up, and the remaining three patients experienced only a single UTI episode at 5, 11, and 13 months following FMT. All three UTI episodes were successfully treated with oral antibiotics.

Organisms isolated from the three post-procedural UTI urine cultures were Klebsiella oxytoca, Proteus mirabilis, and Escherichia coli, respectively. None of which were identified as extended-spectrum beta-lactamase–producing. There was no notable difference in antibiotic susceptibility profiles before and after FMT.

None of the patients experienced an adverse event associated with FMT within the follow-up period.

These findings point to FMT as a promising novel nonantibiotic strategy to prevent UTI recurrence and particularly important in the context of the growing threat of antibiotic resistance, according to the investigators.

Repeated antibiotic use is the key driver of resistance, which itself leads to treatment failure in recurrent UTIs by promoting resistant organisms. FMT breaks this cycle of antibiotic use by targeting the uropathogen reservoir, potentially uprooting the underlying predisposing factor, and thus resulting in UTI resolution, the investigators said. [J Gen Int Med 2025;40:862-870; Antibiotics 2022;11:1382]

“[FMT] also may have the added benefit of the restoration of gut microbial biodiversity and reduction of risk of bowel pathology,” they continued.

A better understanding of the mechanisms at play, according to the investigators, would allow for a more targeted FMT regimen for recurrent UTI.

“The composition of the FMT itself may be standardized and reduced to the active and necessary components. For example, a rigorous analysis of the gastrointestinal and urinary microbiota before and after FMT, together with clinical endpoints, would allow for an improved understanding of the specific bacterial taxa necessary and allow for the development of a standardized and highly accessible therapy,” they said.

The investigators believed that in clinical practice, FMT may be used in conjunction with other therapy to treat patients with refractory recurrent UTI. “Our results provide groundwork for a randomized-controlled clinical trial to further assess the safety and efficacy of FMT for rUTI.”