Fecal microbiota transplantation may reduce the mortality of patients with severe and fulminant Clostridioides difficile infection compared to standard‐of‐care antibiotics in a community hospital

Abstract

Objectives Clostridioides difficile infection (CDI) is known for significant morbidity and mortality. Fecal microbiota transplantation (FMT) is an effective therapy for recurrent and resistant CDI. However, its impact on the mortality rate of patients with severe and fulminant CDI has not been rigorously studied yet. We aimed to evaluate the effectiveness of FMT on the mortality rate of patients with severe or fulminant CDI in a community hospital system. Methods Our study included 106 inpatients with severe or fulminant CDI. Both standard‐of‐care (SOC) and FMT were provided to 14 (13.2%) patients (the FMT group). SOC antibiotics alone were provided to 92 (86.8%) patients, out of whom 28 patients were included via propensity score matching in a 2:1 ratio (the SOC group). The primary outcome was defined as the composite end‐point of mortality during admission, within 30 and 90 days after discharge, and discharge with comfort measures only. Each component was a secondary end‐point. Results The primary outcome rate in the FMT group was 7.1% (1/14) compared to 25.0% (7/28) in the SOC group. Univariate analysis demonstrated that FMT decreases mortality (odds ratio [OR] 0.08, 95% confidence interval [CI] 0.01–0.58, P = 0.01). However, multivariate regression did not show statistical significance (OR 0.15, 95% CI 0.01–2.53, P = 0.19), possibly due to the small sample size. Conclusions FMT may decrease the mortality of patients with severe and fulminant CDI. Large studies are needed to validate these findings.

Fecal Microbiota Transplantation for Fulminant Clostridioides Difficile Infection: A Combined Medical and Surgical Case Series

“…Another retrospective series examined mortality in patients with either fulminant CDI or severe refractory CDI before and after implementation of an inpatient FMT program; the authors found that CDI-related mortality was significantly decreased in both cohorts of patients after implantation of the inpatient FMT program [4]. A retrospective series reported mortality in patients with severe or fulminant CDI who received FMT and demonstrated reduced mortality when evaluated using univariable analysis but not when evaluated by multivariable analysis; these findings may have been due to the small sample size [20].…”

Washed microbiota transplantation for Clostridioides difficile infection: A national multicenter real‐world study

“…The potential benefits of expanding the indications of FMT to primary CDI have been proposed, and trials are currently underway. Additionally, it has been reported that FMT may reduce the mortality of patients with severe and fulminant CDI when compared to standard antibiotic therapy 11 …”

“…Additionally, it has been reported that FMT may reduce the mortality of patients with severe and fulminant CDI when compared to standard antibiotic therapy. 11 The latest microbiota-based therapeutics originating from FMT mainly involve the application of a washed preparation of fecal microbiota using automatic machine and device in China, 12,13 and the development of fecal microbiota suspension (RBX2660) and collection of Firmicutes spores from feces (SER-109) in the United States. 6,7 An improved method of FMT based on the automatic washing process and the related delivery decisions was developed as washed microbiota transplantation (WMT), 14 of which a consensus has been established by the FMT-standardization Study Group in China in 2020.…”