Fecal Microbiota Transplantation for Refractory Clostridioides Difficile Infection Is Effective and Well Tolerated Even in Very Old Subjects: A Real-Life Study

Abstract

Objectives Fecal microbiota transplantation (FMT) is an innovative therapy indicated for the treatment of recurrent Clostridioides difficile infections. Although CDI and its complications are more common in very old patients (≥80 years) due to their comorbidities, frailty and senescence of the immune system, limited data are available for this older patient population. Design This was a single-center, real-life cohort study with retrospective outcome data registration, conducted at Toulouse, France. Setting and Participants Older people group was compared to the control group aged 18–79 years. Measurements The primary outcome was overall survival at 52 weeks for ≥80 years patients compared to the control group after FMT. Recurrence-free survival at 52 weeks and, the occurrence of adverse events in the short and long term were the secondary endpoints. Results A total of 58 patients were included, 19 were aged ≥80 years and 39 were aged 18–79 years. Overall survival at 52 weeks after FMT of the very old patients was not different from the control group (78.9% versus 89.7%, p= 0.29). Recurrence-free survival of CDI was not different between groups, with 94.3% in the 18–79-group versus 86.9% in the ≥80 group (p=0.44). The occurrence of short- or long-term adverse events was not statistically different between the two groups (36.8% vs 41%, p=0.45). Conclusions FMT is effective and well-tolerated in very old frail patients. This treatment brings a rapid benefit and limits the loss of functions. It also favors their maintenance at home or in a non-medical institution dedicated to dependent subjects and improves their quality of life.

Fecal microbiota transplantation for recurrent Clostridioides difficile infection in frail and very old patients

“…Our results confirm the recent report by Nivet et al 15 evaluating the efficacy and safety of FMT in a small cohort of 19 rCDI patients aged over 80 years compared to a control group of 39 younger patients. In this study, there were no significant differences in overall survival and recurrence‐free survival at 52 weeks, nor in adverse events in the short and long term.…”

“…However, the assessment of baseline functional status by CFS did not help in recognizing predictive factors of worse outcomes in the older group. Our study extends the Nivet study 15 with a larger and older cohort of patients with rCDI, undergoing successful treatment with FMT.…”

“…Older age is a well‐established risk factor for rCDI and severe CDI 2 ; however, in clinical practice, there is still uncertainty about the efficacy and safety of FMT in very old patients. Studies aimed to establish the efficacy and safety of FMT in these subjects are few, 5,10–15 and most of them are limited by a small sample size 11,13–15 . In addition, they are often biased by a currently anachronistic cut‐off of 65 years to identify older adults, 10–14 without exploring a large part of the population belonging to more extreme age groups.…”

Clostridioides difficile infection in frail older patients, quality in treatment and care: the CLODIFRAIL study protocol for a multicentre randomised controlled trial

“…It is effective for rst and recurrent CDI in achieving sustained resolution (31,32) and tends to reduce mortality rates compared with vancomycin treatment alone (33). Limited data support that FMT has similar effect and safety pro le in patients aged ≥ 65 years (34)(35)(36)(37). Despite its bene ts to this population at risk of recurrence and severe disease (37), access to this treatment remains limited.…”

“…Limited data support that FMT has similar effect and safety pro le in patients aged ≥ 65 years (34)(35)(36)(37). Despite its bene ts to this population at risk of recurrence and severe disease (37), access to this treatment remains limited. In most settings, FMT requires hospital attendance.…”