Fecal calprotectin and need of multiple microbiota trasplantation infusions in Clostridium difficile infection

Abstract

Background and Aim Fecal microbiota transplantation (FMT) has proven to be very effective in recurrent Clostridium difficile infection (CDI) when compared with standard antibiotic therapy. However, given the lack of validated criteria, decision regarding number and timing of infusions is currently based on the clinician's experience, severity of infection, and clinical response. We performed a longitudinal assessment of fecal calprotectin concentration (FCC) in CDI patients undergoing FMT. FCCs were correlated with the need for multiple infusions and with the clinical status of the patient. Methods Fecal calprotectin concentration measurement was performed just before first procedure (T0) and 2 (T1) and 5 (T2) days later. The need for reinfusion was accounted for in the 8 weeks following procedure, and clinical status was evaluated at the end of the given period. Both outcomes were correlated with measured FCCs. Results A total of 28 CDI patients undergoing FMT were enrolled. Median FCCs at T0 were significantly higher in patients who needed repeat FMT, 540 μg/g versus patients who underwent single FMT, 290 μg/g (P < 0.05). Differences were not significant for FCC at T1 and T2. Regarding correlation with clinical outcome, median FCC at T0 was found to be lower in responders compared with non‐responders with a trend towards statistical significance (P = 0.07). Correlation at T1 and T2 was not significant. Conclusions The use of an easily obtainable parameter such as fecal calprotectin could possibly optimize overall management of FMT procedural framework potentially being able to immediately identify patients who may benefit from repeat infusions.

Recipient factors in faecal microbiota transplantation: one stool does not fit all

“…Severe and complicated indications, inpatient status during FMT, and the number of previous CDI-related hospitalizations are strongly associated with early FMT failure 99 . Patients who need repeated FMT for rCDI have higher intestinal inflammation than patients cured with one single FMT 100 . rCDI patients with an active IBD requiring medication escalation have reduced FMT success, with no impact of other parameters, such as CDI recurrence 101 .…”

Clinical Practice Guidelines for Fecal Microbiota Transplantation in Korea

“…In studies selected by our committee, 2 studies, including an RCT, defined primary outcome as a progressive reduction in diarrhea and clinical improvement within 1 week after FMT in patients with CDI. 92,93 In other studies, the short-term duration of follow-up ranged between 2 weeks and 1 month. 71,91,94 When FMT is conducted for CDI, symptom resolution was achieved within 1 week of FMT.…”

Immunological consequences of microbiome-based therapeutics

“…Clinical studies assessing the host inflammatory status prior to FMT further highlight the importance of immune status in transplant engraftment and thereby efficacy of such therapies. For example, recurrent C. difficile patients that have higher intestinal inflammation prior FMT, as measured by fecal calprotectin level, are more likely to require repeated FMT administration to resolve infection ( 121 ). Further, patients with recurrent C. difficile infection that have underlying IBD experience reduced beneficial effects following FMT therapy ( 122 ).…”