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News

Fecal microbiota transplant treats C. difficile in immunocompromised patients

A study in this month's issue of the American Journal of Gastroenterology examines fecal microbiota transplant for the treatment of Clostridium difficile infection in immunocompromised patients.

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Patients who are immunocompromised are at increased risk of Clostridium difficile infection (CDI), which has increased to epidemic proportions over the past decade.

Fecal microbiota transplantation (FMT) appears effective for the treatment of Clostridium difficile, although there is concern that immunocompromised patients may be at increased risk of having adverse events related to FMT.

Dr Colleen Kelly and colleagues from Rhode Island, USA describe the multicenter experience of FMT in immunocompromised patients.

A multicenter retrospective series was performed on the use of FMT in immunocompromised patients with Clostridium difficile that was recurrent, refractory, or severe.

The research team described rates of Clostridium difficile cure after FMT as well as adverse events experienced by immunocompromised patients after FMT.

79% were outpatients at the time of FMT
American Journal of Gastroenterology

A 32-item questionnaire soliciting demographic and pre- and post-FMT data was completed for 99 patients at 16 centers, of whom 80 were eligible for inclusion.

Outcomes included rates of Clostridium difficile cure after FMT, serious adverse events such as death or hospitalization within 12 weeks of FMT, infection within 12 weeks of FMT, and adverse events.

Cases included 75 adult and 5 pediatric patients treated with FMT for recurrent, refractory, and severe and/or overlap of recurrent/refractory and severe Clostridium difficile.
 
The team noted that in all, 79% were outpatients at the time of FMT.

The mean follow-up period between FMT and data collection was 11 months.

Reasons for immunocompromise included HIV/AIDS, solid organ transplant, oncologic condition, immunosuppressive therapy for inflammatory bowel disease, and other medical conditions/medications.

The research team found that the Clostridium difficile cure rate after a single FMT was 78%, with 62 patients suffering no recurrence at least 12 weeks post FMT.

The team identified 12 patients who underwent repeat FMT, of whom 8 had no further Clostridium difficile.

Thus, the overall cure rate was 89%.

The researchers found that 15% had any serious adverse event within 12 weeks post FMT, of which 10 were hospitalizations.

The team observed 2 deaths occurred within 12 weeks of FMT, one of which was the result of aspiration during sedation for FMT administered via colonoscopy, and the other was unrelated to FMT.

None suffered infections definitely related to FMT, but 2 patients developed unrelated infections and 5 had self-limited diarrheal illness in which no causal organism was identified.

The team found 1 patient had a superficial mucosal tear caused by the colonoscopy performed for the FMT, and 3 patients reported mild, self-limited abdominal discomfort post FMT.

About 14% of patients experienced disease flare post FMT.

The research team noted 3 ulcerative colitis patients that underwent colectomy related to course of UC >100 days after FMT.

Dr Kelly's team concludes, "This series demonstrates the effective use of FMT for Clostridium difficile in immunocompromized patients with few serious adverse events or related adverse events."

"Importantly, there were no related infectious complications in these high-risk patients."

Am J Gastroenterol 2014; 109:1065–1071
11 July 2014

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