Fecal transplant is as effective and safe in immunocompromised as non-immunocompromised patients for Clostridium difficile

Abstract

Clostridium difficile infection (CDI) is a leading cause of nosocomial infection and isassociated with significant morbidity and mortality. Immunocompromised (IC) patients are particularly at higher risk. Recurrence rates of up to 60 % have been reported after the third episode despite treatment with antibiotics. Recent published reports of fecal microbiota transplantation (FMT) in the IC population have shed light that the procedure proves to be effective and safe. No studies that compare the efficacy and adverse event rate of FMT between IC and non-IC patients currently exist The aim of our study is to compare the response and serious adverse event (SAE) rates of FMT for recurrent or refractory CDI (RCDI) between IC patients and non-IC patients.We performed a single-center retrospective study on patients who received FMT for RCDI in a single tertiary care center. Donor stool was obtained from a universal donor, friend, or relative. We used a standardized protocol for preparation of stool used for FMT. Patients received FMT through the upper gastrointestinal route or by colonoscopy. Those who failed initial FMT were eligible to receive additional FMT.Patients were considered IC as a result of one or more of the following: HIV infection (any CD4 count), AIDS-defining diagnosis or CD4<200/mm 3 , inherited or primary immune disorders, active malignancy, and immunodeficient or immunosuppressed from a medical condition/medication including current or recent (<3 months) treatment with anti-neoplastic

Fecal microbiota transplantation in recurrent Clostridium difficile infection: A retrospective single‐center chart review

“…On further review, these patients included both IBD and non‐IBD patients. Our study showed that there was no statistical significant difference in the success of FMT in patients on immunosuppressive therapy when compared to patients not on immunosuppression, which is in alignment with existing literature . Although our population of patients on immunosuppression was small, our cure rate in this subset population on immunosuppression was 62.5% after first FMT compared to existing literature that has reported a cure rate of 78% .…”

“…Our study showed that there was no statistical significant difference in the success of FMT in patients on immunosuppressive therapy when compared to patients not on immunosuppression, which is in alignment with existing literature. 5 Although our population of patients on immunosuppression was small, our cure rate in this subset population on immunosuppression was 62.5% after first FMT compared to existing literature that has reported a cure rate of 78%. 14 Furthermore, when examining the patients with IBD, there was no statistically significant difference in the success of FMT for patients with active or inactive IBD.…”

“…Clostridium difficile (C. difficile) has long been recognized as the most common infectious cause of nosocomial diarrhea [1][2][3][4][5] and has led to ever expanding health-care costs. 2 In the United States, the rates of C. difficile infection (CDI) are not accurately known as it is not a reportable illness.…”

Successful treatment of fulminant Clostridioides difficile infection with emergent fecal microbiota transplantation in a patient with acute myeloid leukemia and prolonged, severe neutropenia

“…In our review, we could not find any published reports of post‐FMT bacteremia after flexible sigmoidoscopy administration. Studies published on immunocompromised patients who underwent FMT (through upper gastrointestinal route or colonoscopy) did not report FMT‐related bacteremia, although only one these studies included fulminant infections …”

“…did not report FMT-related bacteremia, although only one these studies included fulminant infections. 6,7,19,20…”