Fecal microbiota transplantation (FMT) for Clostridium difficile infection: Focus on immunocompromised patients

Bella, Stefano Di; Gouliouris, Theodore; Petrosillo, Nicola

doi:10.1016/j.jiac.2015.01.011

Cited by 66 publications

(39 citation statements)

References 111 publications

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“…A febrile episode after the second FMT resolved within 1 day and no pathogens were detected. These results thus suggest that normal microbiota 12,13 might be administered safely in SCT patients (for the detailed clinical course of each patient, please see supplemental Results and discussion).…”

Section: Resultsmentioning

confidence: 78%

Fecal microbiota transplantation for patients with steroid-resistant acute graft-versus-host disease of the gut

Kakihana

Fujioka

Suda

et al. 2016

Blood

312

262

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Section: Resultsmentioning

confidence: 78%

Fecal microbiota transplantation for patients with steroid-resistant acute graft-versus-host disease of the gut

Kakihana

Fujioka

Suda

et al. 2016

Blood

312

262

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“…Fecal microbiota transplant has been utilized in medicine for treatment of many conditions including refractory C. diff colitis (4, 28). C. diff colitis most often results from antibiotic-induced changes to the microbiome (29).…”

Section: Resultsmentioning

confidence: 99%

Fecal Microbiota Transplant Restores Mucosal Integrity in a Murine Model of Burn Injury

Kuethe

Armocida

Rice

et al. 2016

Shock

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The gut microbiome is a community of commensal organisms that are known to play a role in nutrient production as well as gut homeostasis. The composition of the gut flora can be affected by many factors; however, the impact of burn injury on the microbiome is not fully known. Here, we hypothesized that burn-induced changes to the microbiome would impact overall colon health. After scald-burn injury, cecal samples were analyzed for aerobic and anaerobic colony forming units, bacterial community, and butyrate levels. In addition, colon and total intestinal permeabilities were determined. These parameters were further determined in a germ-reduced murine model. Following both burn injury and germ reduction, we observed decreases in aerobic and anaerobic bacteria, increased colon permeability and no change to small intestinal permeability. After burn injury, we further observed a significant decrease in the butyrate producing bacteria R. Gnavus, C. Eutactus, and Roseburia species as well as decreases in colonic butyrate. Finally, in mice that underwent burn followed by fecal microbiota transplant, bacteria levels and mucosal integrity were restored. Altogether our data demonstrate that burn injury can alter the microbiome leading to decreased butyrate levels and increased colon permeability. Of interest, fecal microbiota transplant treatment was able to ameliorate the burn-induced changes in colon permeability. Thus, fecal transplantation may represent a novel therapy in restoring colon health after burn injury.

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“…Published studies used for this analysis were limited to immunocompetent patients. However, FMT has been shown to be safe, well tolerated, and effective also in immunocompromised patients [83,84]. Two recent randomized controlled trials have shown similar cure rates between frozen FMT and fresh FMT in treating recurrent CDI [74,85].…”

Section: Discussionmentioning

confidence: 99%

Cost-Effectiveness Analysis of Five Competing Strategies for the Management of Multiple Recurrent Community-Onset Clostridium difficile Infection in France

et al. 2017

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BackgroundClostridium difficile infection (CDI) is characterized by high rates of recurrence, resulting in substantial health care costs. The aim of this study was to analyze the cost-effectiveness of treatments for the management of second recurrence of community-onset CDI in France.MethodsWe developed a decision-analytic simulation model to compare 5 treatments for the management of second recurrence of community-onset CDI: pulsed-tapered vancomycin, fidaxomicin, fecal microbiota transplantation (FMT) via colonoscopy, FMT via duodenal infusion, and FMT via enema. The model outcome was the incremental cost-effectiveness ratio (ICER), expressed as cost per quality-adjusted life year (QALY) among the 5 treatments. ICERs were interpreted using a willingness-to-pay threshold of €32,000/QALY. Uncertainty was evaluated through deterministic and probabilistic sensitivity analyses.ResultsThree strategies were on the efficiency frontier: pulsed-tapered vancomycin, FMT via enema, and FMT via colonoscopy, in order of increasing effectiveness. FMT via duodenal infusion and fidaxomicin were dominated (i.e. less effective and costlier) by FMT via colonoscopy and FMT via enema. FMT via enema compared with pulsed-tapered vancomycin had an ICER of €18,092/QALY. The ICER for FMT via colonoscopy versus FMT via enema was €73,653/QALY. Probabilistic sensitivity analysis with 10,000 Monte Carlo simulations showed that FMT via enema was the most cost-effective strategy in 58% of simulations and FMT via colonoscopy was favored in 19% at a willingness-to-pay threshold of €32,000/QALY.ConclusionsFMT via enema is the most cost-effective initial strategy for the management of second recurrence of community-onset CDI at a willingness-to-pay threshold of €32,000/QALY.

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Fecal microbiota transplantation (FMT) for Clostridium difficile infection: Focus on immunocompromised patients

Cited by 66 publications

References 111 publications

Fecal microbiota transplantation for patients with steroid-resistant acute graft-versus-host disease of the gut

Fecal microbiota transplantation for patients with steroid-resistant acute graft-versus-host disease of the gut

Fecal Microbiota Transplant Restores Mucosal Integrity in a Murine Model of Burn Injury

Cost-Effectiveness Analysis of Five Competing Strategies for the Management of Multiple Recurrent Community-Onset Clostridium difficile Infection in France

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