Fecal microbiota transplant for <i>Clostridium difficile</i> infection in older adults

Tauxe, William M.; Haydek, John P.; Rebolledo, Paulina A.; Neish, Emma; Newman, Kira L.; Ward, Angela; Dhere, Tanvi; Kraft, Colleen S.

doi:10.1177/1756283x15622600

Cited by 14 publications

(14 citation statements)

References 37 publications

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“…[14][15][16][17][18] Figure 1 shows the flow diagram of study selection. Fifteen studies, published between 2012 and 2017, were included for the final analysis, 4,11,[19][20][21][22][23][24][25][26][27][28][29][30][31] including two RCTs, 4,11 nine retrospective case series [19][20][21][22][24][25][26][27]29 and four prospective case series. 23,28,30,31 Most were single-centre studies and three were multicentre studies.…”

Section: Data Synthesis and Statistical Analysismentioning

confidence: 99%

Efficacy of different faecal microbiota transplantation protocols for Clostridium difficile infection: A systematic review and meta‐analysis

Maida²,

et al. 2018

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Background: Protocols for treating recurrent Clostridium difficile infection (rCDI) through faecal microbiota transplantation (FMT) are still not standardised. Our aim was to evaluate the efficacy of different FMT protocols for rCDI according to routes, number of infusions and infused material. Methods: MEDLINE, Embase, SCOPUS, Web of Science and the Cochrane Library were searched through 31 May 2017. Studies offering multiple infusions if a single infusion failed to cure rCDI were included. Data were combined through a random effects meta-analysis. Results: Fifteen studies (1150 subjects) were analysed. Multiple infusions increased efficacy rates overall (76% versus 93%) and in each route of delivery (duodenal delivery: 73% with single infusion versus 81% with multiple infusions; capsule: 80% versus 92%; colonoscopy: 78% versus 98% and enema: 56% versus 92%). Duodenal delivery and colonoscopy were associated, respectively, with lower efficacy rates (p ¼ 0.039) and higher efficacy rates (p ¼ 0.006) overall. Faecal amount 50 g (p ¼ 0.006) and enema (p ¼ 0.019) were associated with lower efficacy rates after a single infusion. The use of fresh or frozen faeces did not influence outcomes. Conclusions: Routes, number of infusions and faecal dosage may influence efficacy rates of FMT for rCDI. These findings could help to optimise FMT protocols in clinical practice. Key summary. Faecal microbiota transplantation (FMT) is highly effective against recurrent Clostridium difficile infection (rCDI). . However, there is still no clear evidence supporting the superiority of one working protocol over another.. Routes of delivery, number of infusions and faecal dosage may influence efficacy of FMT for rCDI. . These findings may be useful to optimise FMT protocols in clinical practice.

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Section: Data Synthesis and Statistical Analysismentioning

confidence: 99%

Efficacy of different faecal microbiota transplantation protocols for Clostridium difficile infection: A systematic review and meta‐analysis

Maida²,

et al. 2018

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“…[ 26 ] The risk of CDI is greater if the prevalence of CDI at the hospital is high during an admission, a concept known as “colonization pressure.”[ 27 ] Inflammatory bowel disease, chemotherapy, ongoing malignancy, chronic kidney and liver disease, pregnancy, HIV infection, chronic corticosteroid treatment, and gastrointestinal (GI) surgery or manipulation (including feeding tubes) are additional risk factors. [ 6 11 12 28 29 30 31 ] The recent increase in the incidence of CDI may be due to demographic changes among admitted patients, including older age, multi-morbidity, polypharmacy, as well as the emergence of the BI/NAP/027 strain. [ 6 32 ] Recurrent CDI (RCDI) has been associated with continued use of antibiotics, severe initial CDI, older age, multiple comorbidities, and gastric acid suppression therapy.…”

Section: Introductionmentioning

confidence: 99%

Early results of fecal microbial transplantation protocol implementation at a community-based university hospital

Duarte-Chavez

Wojda

Zanders

et al. 2018

J Global Infect Dis

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Introduction:Clostridium difficile (CD) is a serious and increasingly prevalent healthcare-associated infection. The pathogenesis of CD infection (CDI) involves the acquisition of CD with a concurrent disruption of the native gut flora. Antibiotics are a major risk although other contributing factors have also been identified. Clinical management combines discontinuation of the offending antibiotic, initiation of CD-specific antibiotic therapy, probiotic agent use, fecal microbiota transplantation (FMT), and surgery as the “last resort” option. The aim of this study is to review short-term clinical results following the implementation of FMT protocol (FMTP) at our community-based university hospital.Methods:After obtaining Institutional Review Board and Infection Control Committee approvals, we implemented an institution-wide FMTP for patients diagnosed with CDI. Prospective tracking of all patients receiving FMT between July 1, 2015, and February 1, 2017, was conducted using REDCap™ electronic data capture system. According to the FMTP, indications for FMT included (a) three or more CDI recurrences, (b) two or more hospital admissions with severe CDI, or (c) first episode of complicated CDI (CCDI). Risk factors for initial infection and for treatment failure were assessed. Patients were followed for at least 3 months to monitor for cure/failure, relapse, and side effects. Frozen 250 mL FMT samples were acquired from OpenBiome (Somerville, MA, USA). After 4 h of thawing, the liquid suspension was applied using colonoscopy, beginning with terminal ileum and proceeding distally toward mid-transverse colon. Monitored clinical parameters included disease severity (Hines VA CDI Severity Score or HVCSS), concomitant medications, number of FMT treatments, non-FMT therapies, cure rates, and mortality. Descriptive statistics were utilized to outline the study results.Results:A total of 35 patients (mean age 58.5 years, 69% female) were analyzed, with FMT-attributable primary cure achieved in 30/35 (86%) cases. Within this subgroup, 2/30 (6.7%) patients recurred and were subsequently cured with long-term oral vancomycin. Among five primary FMT failures (14% total sample), 3 (60%) achieved medical cure with long-term oral vancomycin therapy and 2 (40%) required colectomy. For the seven patients who either failed FMT or recurred, long-term vancomycin therapy was curative in all but two cases. For patients with severe CDI (HVCSS ≥3), primary and overall cure rates were 6/10 (60%) and 8/10 (80%), respectively. Patients with CCDI (n = 4) had higher HVCSS (4 vs. 3) and a mortality of 25%. Characteristics of patients who failed initial FMT included older age (70 vs. 57 years), female sex (80% vs. 67%), severe CDI (80% vs. 13%), and active opioid use during the initial infection (60% vs. 37%) and at the time of FMT (60% vs. 27%). The most commonly reported side effect of FMT was loose stools.Conclusions:This pilot study supports the efficacy and safety of FMT administration for CDI in the setting of a community-based university ho...

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“…A small case review study of 31 patients aged 65 years or older showed CDI revolved in 27/31 patients. In this analysis, five deaths occurred in follow-up, although the FMT was not thought to be a causative factor in these cases, and four patients reported subjective worsening of their arthritis post-FMT leading the study to conclude that FMT is generally a safe and effective treatment even in older adults with CDI [74].…”

Section: Safety Of Fmtmentioning

confidence: 80%

Fecal Microbiota Transplantation for the Management ofClostridium difficileInfection

Paknikar

Pekow

2018

Surgical Infections

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The clinical burden of Clostridium difficile infection (CDI) continues to grow. Despite the multitude of treatment options that have been developed and tested to combat the morbidity and death associated with CDI, recurrence remains common. As such, treatment modalities such as fecal microbiota transplantation (FMT) have become studied increasingly; FMT serves to transplant stool from carefully selected healthy subjects into C. difficile positive patients through a variety of delivery routes. In doing so, FMT is hypothesized to correct dysbiosis of the recipient gut microbiome addressing the root cause of the pathogenesis of C. difficile infection. A growing body of evidence shows FMT to be efficacious in this setting, and the study of FMT accordingly continues to evolve to identify novel indications for its utilization.

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Fecal microbiota transplant for Clostridium difficile infection in older adults

Abstract: FMT is a generally safe and effective treatment option for older adults with CDI.

Cited by 14 publications

References 37 publications

Efficacy of different faecal microbiota transplantation protocols for Clostridium difficile infection: A systematic review and meta‐analysis

Efficacy of different faecal microbiota transplantation protocols for Clostridium difficile infection: A systematic review and meta‐analysis

Early results of fecal microbial transplantation protocol implementation at a community-based university hospital

Fecal Microbiota Transplantation for the Management ofClostridium difficileInfection

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