BACKGROUND: Clostridium difficile infection (CDI) is a major infectious disease focus for which fecal microbiota transplantation (FMT) has been used with success in various patient populations. METHODS: We conducted a retrospective study of FMT in immunocompetent and immunocompromised patients to review outcomes at our center, with a focus on identifying risk factors for FMT failure in solid organ transplant (SOT) patients. FMT was conducted using universal banked frozen stool via naso-duodenal tube in patients with recurrent CDI of 3 or more episodes per our institutional protocol. RESULTS: Thirteen patients were included in the analysis, 6 who were immunocompetent and 7 who were immunocompromised. Of these, 6 patients had a history of SOT and were primarily abdominal organ recipients. All immunocompetent patients experienced success with FMT, while 3 immunocompromised SOT patients experienced failure. Two patients who failed FMT had a second FMT, which was successful in one patient and failed in the second patient. No adverse events were noted with FMT administration. A predictor of FMT failure was antimicrobial exposure pre-FMT. CONCLUSIONS: This study highlights the safe use of FMT for recurrent CDI with variable efficacy in immunocompromised patients. Antimicrobial exposure prior to FMT was an identified risk factor for FMT failure. The use of sequential FMT in SOT patients may be considered but ultimately requires further investigation.
BACKGROUND:Clostridium difficileinfection (CDI) is a major infectious disease focus for which fecal microbiota transplantation (FMT) has been used with success in various patient populations. METHODS: We conducted a retrospective study of FMT in immunocompetent and immunocompromised patients to review outcomes at our center, with a focus on identifying risk factors for FMT failure in solid organ transplant (SOT) patients. FMT was conducted using universal banked frozen stool via naso-duodenal tube in patients with recurrent CDI of 3 or more episodes per our institutional protocol. RESULTS: Thirteen patients were included in the analysis, 6 who were immunocompetent and 7 who were immunocompromised. Of these, 6 patients had a history of SOT and were primarily abdominal organ recipients. All immunocompetent patients experienced success with FMT, while 3 immunocompromised SOT patients experienced failure. Two patients who failed FMT had a second FMT, which was successful in one patient and failed in the second patient. No adverse events were noted with FMT administration. A predictor of FMT failure was antimicrobial exposure pre-FMT. CONCLUSIONS: This study highlights the safe use of FMT for recurrent CDI with variable efficacy in immunocompromised patients. Antimicrobial exposure prior to FMT was an identified risk factor for FMT failure. The use of sequential FMT in SOT patients may be considered but ultimately requires further investigation.
Authors: Mehmet Yalchin; Jonathan P Segal; Benjamin H Mullish; Mohammed Nabil Quraishi; Tariq H Iqbal; Julian R Marchesi; Ailsa L Hart Journal: Therap Adv Gastroenterol Date: 2019-11-25 Impact factor: 4.409
Authors: Josbert J Keller; Rogier E Ooijevaar; Christian L Hvas; Elisabeth M Terveer; Simone C Lieberknecht; Christoph Högenauer; Perttu Arkkila; Harry Sokol; Oleksiy Gridnyev; Francis Mégraud; Patrizia K Kump; Radislav Nakov; Simon D Goldenberg; Reetta Satokari; Sergiy Tkatch; Maurizio Sanguinetti; Giovanni Cammarota; Andrey Dorofeev; Olena Gubska; Gianluca Laniro; Eero Mattila; Ramesh P Arasaradnam; Shiv K Sarin; Ajit Sood; Lorenza Putignani; Laurent Alric; Simon M D Baunwall; Juozas Kupcinskas; Alexander Link; Abraham G Goorhuis; Hein W Verspaget; Cyriel Ponsioen; Georgina L Hold; Herbert Tilg; Zain Kassam; Ed J Kuijper; Antonio Gasbarrini; Chris J J Mulder; Horace R T Williams; Maria J G T Vehreschild Journal: United European Gastroenterol J Date: 2021-03-09 Impact factor: 4.623