Efficacy and Safety of, and Patient Satisfaction with, Colonoscopic-Administered Fecal Microbiota Transplantation in Relapsing and Refractory Community- and Hospital-Acquired <i>Clostridium difficile</i> Infection

Khan, Muhammad Ali; Sofi, Aijaz; Ahmad, Usman; Alaradi, Osama; Khan, Abdur Rahman; Hammad, Tariq; Pratt, Jennifer; Sodeman, Thomas; Sodeman, William A.; Kamal, Sehrish; Nawras, Ali

doi:10.1155/2014/695029

Cited by 26 publications

(39 citation statements)

References 10 publications

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“…The details and characteristics of the included studies are presented in Table . The 18 selected studies yielded a total of 611 patients . Eleven of 18 studies reported a mean or median age over 60 years; 62.7% (396/611) of patients were female.…”

Section: Resultsmentioning

confidence: 99%

“…Only 4 of 18 studies carried out consecutive case recruit‐ment, according to reviewers . While seven studies showed a stratified outcome, all studies had a clear main finding according to reviewers. Other detailed information was clarified in Table .…”

Section: Resultsmentioning

confidence: 99%

“…Our third analysis compared the efficacy of lower gastrointestinal with upper gastrointestinal delivery. Fourteen studies were included in our analysis. One study used multiple routes of FMT but provided individually assessed, separated raw data.…”

Section: Resultsmentioning

confidence: 99%

“…The relation of death and FMT ranged from unrelated to possibly related. Almost 69 cases of gastrointestinal symptoms were reported by 11 studies; of these, the most common were boating/flatulence, abdominal pain/cramping and diarrhoea. Almost all these symptoms were short‐lived, moderate and manageable.…”

Section: Resultsmentioning

confidence: 99%

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Systematic review with meta-analysis: long-term outcomes of faecal microbiota transplantation forClostridium difficileinfection

Cai

Wang

et al. 2015

Aliment Pharmacol Ther

142

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Summary Background Clostridium difficile infection is a major cause of nosocomial diarrhoea. Aim To evaluate long‐term (≥90 days) efficacy and safety of faecal microbiota transplantation for C. difficile infection and explore the factors affecting the faecal microbiota transplantation outcomes. Methods MEDLINE, the Cochrane Library and EMBASE were searched and only observational studies that utilised faecal microbiota transplantation for C. difficile infection with long‐term follow‐up duration (≥90 days) were included. Primary cure rate, overall recurrence rate and early (<90 days) and late (≥90 days) recurrence rate were calculated. Results Eighteen observational studies with 611 patients were included. The primary cure rate was 91.2% (95% confidence interval, CI 86.7–94.8%). The overall recurrence rate was 5.5% (95% CI 2.2–10.3%). The early recurrence rate and late recurrence rate were 2.7% (95% CI 0.7–6.0%) and 1.7% (95% CI 0.4–4.2%) respectively. Most adverse events were expected, short‐lived, self‐limited and manageable. The association between faecal microbiota transplantation therapy and adverse events such as inflammatory bowel disease flare, infectious disease and autoimmune disease was a concern but remained insignificant. Old age (≥65 years) was identified as a risk factor for after faecal microbiota transplantation therapy. Upper gastrointestinal administration also results in less frequent primary cure. Conclusions Faecal microbiota transplantation seems to be a highly effective and robust therapy for recurrent C. difficile infection. However, more quality studies, such as randomised controlled trials and cohort studies with control groups, are needed to confirm its long‐term efficacy and safety.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Systematic review with meta-analysis: long-term outcomes of faecal microbiota transplantation forClostridium difficileinfection

Cai

Wang

et al. 2015

Aliment Pharmacol Ther

142

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“…Nevertheless, we maintain that hospitalization with C. difficile equates with intestinal perturbation of the microbiota. The arguments are (1) C. difficile, although ubiquitous in the environment, occurs almost exclusively in individuals receiving antibiotics, proton pump inhibitors, H 2 receptor antagonists, and other drugs that disrupt the bacterial composition of the gastrointestinal tract (42,43); (2) antibiotic stewardship programs decrease the incidence of CDI through reduction in antibiotic use (44); and, most importantly, (3) restoring the normal gut microbiome in persons with CDI cures the disease (15,45). Although CDI may not be the only instance in which dysbiosis occurs, it is certainly a hallmark indication of intestinal perturbation.…”

Section: Discussionmentioning

confidence: 99%

Hospitalization Type and Subsequent Severe Sepsis

Prescott

Dickson²,

Rogers

et al. 2015

Am J Respir Crit Care Med

133

102

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Rationale: Hospitalization is associated with microbiome perturbation (dysbiosis), and this perturbation is more severe in patients treated with antimicrobials.Objectives: To evaluate whether hospitalizations known to be associated with periods of microbiome perturbation are associated with increased risk of severe sepsis after hospital discharge.Methods: We studied participants in the U.S. Health and Retirement Study with linked Medicare claims (1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010). We measured whether three hospitalization types associated with increasing severity of probable dysbiosis (non-infection-related hospitalization, infection-related hospitalization, and hospitalization with Clostridium difficile infection [CDI]) were associated with increasing risk for severe sepsis in the 90 days after hospital discharge. We used two study designs: the first was a longitudinal design with between-person comparisons and the second was a self-controlled case series design using within-person comparison.Measurements and Main Results: We identified 43,095 hospitalizations among 10,996 Health and Retirement Study-Medicare participants. In the 90 days following non-infectionrelated hospitalization, infection-related hospitalization, and hospitalization with CDI, adjusted probabilities of subsequent admission for severe sepsis were 4.1% (95% confidence interval [CI], 3.8-4.4%), 7.1% (95% CI, 6.6-7.6%), and 10.7% (95% CI, 7.7-13.8%), respectively. The incidence rate ratio (IRR) of severe sepsis was 3.3-fold greater during the 90 days after hospitalizations than during other observation periods. The IRR was 30% greater after an infectionrelated hospitalization versus a non-infection-related hospitalization. The IRR was 70% greater after a hospitalization with CDI than an infection-related hospitalization without CDI.Conclusions: There is a strong dose-response relationship between events known to result in dysbiosis and subsequent severe sepsis hospitalization that is not present for rehospitalization for nonsepsis diagnoses.

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Faecal Microbiota Transplantation as Emerging Treatment in European Countries

Maida¹,

Mcilroy²,

Ianiro³

et al. 2018

Advances in Experimental Medicine and Biology

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Clostridium difficile infection (CDI) is one of the most common healthcare-associated infections in the world and is a leading cause of morbidity and mortality in hospitalized patients.Although several antibiotics effectively treat CDI, some individuals do not respond to these drugs and may be cured by transplanting stool from healthy donors. This procedure, termed Faecal Microbiota Transplantation (FMT), has demonstrated remarkable efficacy as a treatment for recurrent CDI.FMT has also been investigated in other diseases and disorders where perturbations to the gut microbiota have been theorized to play a causative role in pathogenesis and severity, such as inflammatory bowel disease (IBD). Although FMT is currently not recommended to cure IBD patients in clinical practice, several studies have recently been carried out with promising results. The aim of future research is therefore to standardize protocols and develop FMT as a therapeutic option for these patients.This review summarizes data on the use of FMT as a treatment for CDI and IBD, with special attention given to studies conducted in European countries.

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Efficacy and Safety of, and Patient Satisfaction with, Colonoscopic-Administered Fecal Microbiota Transplantation in Relapsing and Refractory Community- and Hospital-Acquired Clostridium difficile Infection

Abstract: FMT was a highly successful and very acceptable treatment modality for treating both community- and hospital-acquired CDI.

Cited by 26 publications

References 10 publications

Systematic review with meta-analysis: long-term outcomes of faecal microbiota transplantation forClostridium difficileinfection

Systematic review with meta-analysis: long-term outcomes of faecal microbiota transplantation forClostridium difficileinfection

Hospitalization Type and Subsequent Severe Sepsis

Faecal Microbiota Transplantation as Emerging Treatment in European Countries

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