Fecal microbiota transplantation in refractory or recurrent Clostridium difficile infection: a real-life experience in a non-academic center

Abstract

Author's contributionAna Ponte: design of the study, analysis and interpretation of the data and references and drafting of the article.Rolando Pinho: design of the study, analysis and interpretation of the data and references, drafting of the article and critical revision of the article for important intellectual content.Margarida Mota: design of the study, analysis and interpretation of the data.Nuno Vieira and Rosa Oliveira: design of the study.Joana Silva, Jaime Rodrigues, Mafalda Sousa and Isabel Sousa: analysis and interpretation of the data and references.João Carvalho: final approval of the article. ABSTRACTAim: this study aimed to describe the efficacy and safety of fecal microbiota transplantation (FMT) for the treatment of refractory and recurrent Clostridium difficile infection (CDI).Methods: this was an observational study of patients with refractory or recurrent CDI treated with FMT between June 2014 and January 2017. Primary and secondary outcomes were the resolution of diarrhea without CDI recurrence within two months after one or more FMT. A descriptive analysis was performed.Results: thirty-four FMT were performed in 28 patients, 88.2% (n = 30) using an upper route with a gastroscopy and 11.8% (n = 4) with colonoscopy; 50% (n = 17) of FMT were due to recurrent CDI and 50% (n = 17) were due to refractory CDI. The overall cure rate of upper FMT was 87.5% (21/24) and 100% (4/4) when colonoscopy was performed. A cure was achieved after one FMT in 88% (22/25) of cases and after two or more FMT in 8% (2/25) of cases, resulting in an overall cure rate of 96% (24/25). No severe adverse events were reported. Conclusion:FMT constitutes an effective and safe approach for the management of refractory and recurrent CDI, with an overall cure rate of 96% and no reported severe adverse events.

Hospitalized Older Patients with Clostridioides difficile Infection Refractory to Conventional Antibiotic Therapy Benefit from Fecal Microbiota Transplant

“…As noted earlier, there is no consensus for best treatment options for CDI refractory to conventional therapy [ 6 ]. Previous studies have included refractory with the recurrent CDI cases and thus, did not evaluate refractory cases separately [ 17 – 20 ] except in one case series from South Korea looking at the response of patients with refractory CDI to FMT [ 21 ] and an observational study evaluating the effect of adapting FMT as institutional practice on overall institutional mortality of patients with refractory CDI [ 22 ]. One difficulty is the definition of “refractory” as opposed to “recurrent”.…”

The use of faecal microbiota transplant as treatment for recurrent or refractory Clostridioides difficile infection and other potential indications: second edition of joint British Society of Gastroenterology (BSG) and Healthcare Infection Society (HIS) guidelines

“…[18][19][20][21][22][23][24] Effectiveness of FMT in patients with refractory or fulminant CDI versus recurrent CDI: there was inconsistent evidence which suggested no difference in effect for these patient groups. [25][26][27][28][29] Effectiveness of FMT in patients with pseudomembranous colitis compared with other patients: there was weak evidence, and it is not clear whether in these patients FMT may be less successful. 19 22 Adverse events in patients with severe, refractory or fulminant CDI: there was weak evidence which suggested there was no increased risk associated with FMT for these types of patients.…”

Fecal Microbiota Transplant for Hematologic and Oncologic Diseases: Principle and Practice

“…FMT restores the diversity of the intestinal microbial compositions to create an ecologic competition between organisms to overcome and treat C. difficile overgrowth. Success rates of nearly 90% have been reported in most studies in patients with recurrent/refractory CDI (Table 1) [24][25][26][27][28]. Restoration of the normal intestinal microbial composition may also successfully eradicate colonization by multidrug resistant organisms such as extendedspectrum beta-lactamase-producing (ESBL) Escherichia coli (E. coli) [29], vancomycin-resistant Enterococcus (VRE) [30], and carbapenem-resistant Enterobacteriaceae (CRE) [30].…”