Safety and efficacy of fecal microbiota transplant in 9 critically ill patients with severe and complicated Clostridium difficile infection with impending colectomy

Abstract

Objective: Significant data support the efficacy and safety of fecal microbiota transplant (FMT) in recurrent Clostridium difficile infection (CDI). The objective of our study was to determine the success rate of FMT in patients diagnosed with severe and complicated CDI with impending colectomy in the intensive care setting.Methods: This was a 2-center study of 9 patients who met the criteria for severe and complicated CDI and had an impending colectomy. All 9 patients had failed conventional antibiotic therapy and were deemed too unstable to undergo a colectomy.Hence, FMT was considered to be the next step in managing their condition.Results: Following FMT there was marked improvement in the patients' clinical status, with the resolution of diarrhea, reduced requirement for vasopressor, and the reduction in abdominal distention and pain. The primary cure rate of our study after a single round of FMT was 78% (7/9). Of the 9 patients 8 (88.88%) avoided a colectomy during the same hospital admission. the CDI-related death rate was 12.5%(1/9) and that of non-CDI was 12.5% (1/9).Conclusion: Our success with FMT in fulminant CDI shows that this therapeutic modality is a promising alternative to a colectomy and could be a potential bowelsaving intervention.

Rescue fecal microbiota transplantation for antibiotic-associated diarrhea in critically ill patients

“…100% (2/2) of abdominal pain, 86.7% (13/15) of diarrhea, 69.2% (9/13) of abdominal distention, and 50% (1/2) of hematochezia can be alleviated by FMT. These results were similar to those of a recent case series which included nine critically ill patients with severe CDI [30]. It indicated that following FMT there was marked improvement in clinical status with resolution of diarrhea and reduction in abdominal distention and pain [30].…”

“…These results were similar to those of a recent case series which included nine critically ill patients with severe CDI [30]. It indicated that following FMT there was marked improvement in clinical status with resolution of diarrhea and reduction in abdominal distention and pain [30]. Alleviation of these abdominal symptoms may improve life quality of the critically ill patients and provided chances for other treatments.…”

“…There were a few case reports and case series about the application of FMT in critically ill patients in the ICU [27–31]. Less attention was paid particularly to the incidence of AEs of FMT in critically ill patients [28, 30]. In this series, 38.9% (7/18) of patients had FMT-related AEs, which was higher than that in previous studies of FMT for non-ICU patients [7, 15, 16, 18].…”

Faecal microbiota transplant decreases mortality in severe and fulminant Clostridioides difficile infection in critically ill patients

“…However, the utility of FMT in severe or fulminant CDI, especially for critically ill, hospitalised patients, is not well described in the current literature. While there have been several publications demonstrating FMT to be safe and effective in this population, much of this data is uncontrolled and does not directly compare patients who received antibiotics plus FMT vs antibiotics alone (standard of care, SOC) . The aim of this study was to assess the outcomes of hospitalised patients with severe or fulminant CDI requiring intensive care who received antibiotics plus FMT compared to SOC.…”

Romanian National Guideline on Translating Fecal Microbiota Transplantation Applications related to Clostridioides difficile Infections into the Local Clinical Practice

“…For refractory CDI, even though exclusion of other causes is required (for example ulcerative colitis, microscopic colitis), FMT as rescue treatment appears encouraging, although few studies have addressed the effects of FMT in patients with refractory or severe CDI [32][33][34][35][36][37]. Furthermore, FMT appeared to decrease mortality in patients with severe CDI refractory to antibiotic therapy [34][35][36]38], and could also be considered as a therapeutic option for this condition, with decision taken on a case-by-case basis.…”