Early Fecal Microbiota Transplantation Improves Survival in Severe Clostridium difficile Infections

Hocquart, Marie; Lagier, Jean-Christophe; Cassir, Nadim; Saïdani, Nadia; Eldin, Carole; Kerbaj, Jad; Delord, M; Valles, Camille; Brouqui, Philippe; Raoult, Didier; Million, Matthieu

doi:10.1093/cid/cix762

Cited by 120 publications

(90 citation statements)

References 43 publications

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“…By utilising both the CCI and IDSA/SHEA guidelines, we were able to objectively classify patients regarding the severity of their CDI as well as their global illness severity. One prior study observed a similar mortality benefit for early FMT in patients with severe CDI but did not include patients with fulminant CDI and had a median CCI of 2, indicating a less severe cohort of patients …”

Section: Discussionmentioning

confidence: 90%

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

Tixier

Verheyen

Ungaro

et al. 2019

Aliment Pharmacol Ther

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Summary Background Severe and fulminant Clostridioides difficile infection is associated with high mortality rates. While faecal microbiota transplant has been shown to be effective for recurrent C difficile infection, there is little data on the utility of faecal microbiota transplant in severe or fulminant C difficile infection. Aim To compare the outcomes of antibiotics and faecal microbiota transplantation vs antibiotics alone (standard of care) in critically ill patients with severe or fulminant C difficile infection. Methods This was a retrospective, matched cohort study in one urban tertiary academic care centre including 48 patients hospitalised with severe or fulminant C difficile infection who required care in intensive care unit. Results Patients who received faecal microbiota transplantation (n = 16) had a 77% decrease in odds for mortality (OR 0.23, 95% CI 0.06‐0.97) with a number needed to treat of 3 to prevent one death. Conclusions Faecal microbiota transplantation provides mortality benefit over standard of care for severe and fulminant C difficile infection and should be considered in critically ill patients.

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Section: Discussionmentioning

confidence: 90%

“…While the average time to FMT in our study was 9 days, it is possible that earlier time to FMT could have improved survival rates. In one retrospective study, early FMT (defined as 2‐4 days after initiating antibiotics) was associated with improved mortality in severe CDI …”

Section: Discussionmentioning

confidence: 99%

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

Tixier

Verheyen

Ungaro

et al. 2019

Aliment Pharmacol Ther

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“…Prior reports of FMT in critically ill patients occurred mostly in the context of CDI, where 1 in 10 patients with CDI requires care in an ICU or colectomy, or dies from CDI . The 2 largest cohort studies to date and the only RCT for severe CDI reported no serious adverse events attributable to FMT in a total of 91 patients with severe‐complicated CDI who received FMT . There does not appear to be an observed increase in risk for perforation attributable to colonoscopy‐delivered FMT.…”

Section: Discussionmentioning

confidence: 94%

“…37 The 2 largest cohort studies to date and the only RCT for severe CDI reported no serious adverse events attributable to FMT in a total of 91 patients with severe-complicated CDI who received FMT. [38][39][40] There does not appear to be an observed increase in risk for perforation attributable to colonoscopy-delivered FMT. Aspiration after an upper endoscopic delivery of FMT was reported in 1 case as a complication of general anesthesia, suggesting there should be judicious evaluation of the merits of an upper FMT delivery in the setting of anesthesia and in CDI complicated by ileus.…”

Section: Safety Considerationsmentioning

confidence: 93%

Fecal Microbiota Transplantation for the Critically Ill Patient

et al. 2018

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The gut microbiome has been implicated in a diversity of diseases, such as irritable bowel syndrome, inflammatory bowel disease, hepatic steatosis, metabolic syndrome, obesity, and anxiety. Current research also suggests the presence of a bidirectional relationship between the composition of the gut microbiome and critical illness. In the critical care setting, multiple factors (eg, use of antibiotics, aberrant nutrition, bloodstream infections, bowel ischemia, and abnormal bowel motility) strongly contribute to intestinal dysbiosis. Conversely, early studies have associated intestinal dysbiosis with worse clinical outcomes in the intensive care unit (ICU), such as infection, organ failure, and mortality. The possibility of intestinal dysbiosis influencing these clinical outcomes has prompted the question of whether microbiome manipulation strategies, such as fecal microbiota transplantation (FMT), may have a role in the management of critical illness. After a literature search of FMT used in the ICU for indications other than Clostridium difficile infections, we found 4 case reports that describe the use of FMT in 5 critically ill patients with systemic inflammatory responses and no clear source of infection. This review discusses the relationship between the gut microbiome and critical illness, early data on the use of FMT in critical care, and safety considerations of FMT in the critically ill and immunocompromised populations.

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“…The 3‐month mortality rates in the FMT group and the non‐FMT group were 12.1% and 42.2%, respectively. Early FMT reduced the mortality of FMT in severe CDI . So far, FMT offered broad spectral potential to treat CDI with high efficacy and minimal adverse events.…”

Section: Clinical Applicationmentioning

confidence: 99%

Current applications of fecal microbiota transplantation in intestinal disorders

Hsu

Wang

Kuo

2019

The Kaohsiung J of Med Scie

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Fecal microbiota transplantation (FMT) had been an ancient remedy for severe illness several centuries ago. Under modern medical analysis and evidence‐based research, it has been proved as an alternative treatment for recurrent Clostridium difficile infection and recent randomized control study also showed that FMT could be an adjuvant treatment for inflammatory bowel disease. As we get a better understanding of the relationship between gut microbiota and systemic disease, FMT became a potential treatment to explore. This article summarized procedures such as donor selection, fecal material preparation, transplantation delivery methods, and adverse events. We also review the present evidence about FMT in clinical practice.

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Early Fecal Microbiota Transplantation Improves Survival in Severe Clostridium difficile Infections

Abstract: Early FMT dramatically reduces mortality and should be proposed as a first-line treatment for severe CDI. Further studies are needed to clarify complications and contraindications. Surgery should be reassessed in this context.

Cited by 120 publications

References 43 publications

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

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

Fecal Microbiota Transplantation for the Critically Ill Patient

Current applications of fecal microbiota transplantation in intestinal disorders

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