Outcomes of a Multidisciplinary Clinic in Evaluating Recurrent Clostridioides difficile Infection Patients for Fecal Microbiota Transplant: A Retrospective Cohort Analysis

Abstract

Fecal microbiota transplantation (FMT) has been shown to be an effective treatment for recurrent Clostridioides difficile infections (rCDIs). We assessed the benefits of a multidisciplinary C. difficile clinic for screening FMT eligibility in patients with rCDI. Patients seen at the University of Virginia Complicated C. difficile Clinic (CCDC) underwent comprehensive evaluation for possible FMT. Patients were eligible for FMT if there was history of greater than two episodes of rCDI. Patients were evaluated for the outcome after evaluation in the clinic. A total of 113 patients were evaluated: 77 were eligible for FMT, of which 25 patients did not undergo FMT. The rate of recurrence at three months and all-cause mortality were 4.5% and 7% for patients who received FMT and 16.7% and 12.5% for eligible patients who did not receive FMT. There were 36 patients who were not eligible for FMT, with two or fewer recurrences and a recurrence rate of 8.8% and all-cause mortality of 6%. One in three patients screened for FMT had a nutritional deficiency diagnosed, with zinc deficiency being most common (20%). Additional diagnoses, including inflammatory bowel disease, were made during the evaluation. FMT is a highly effective treatment for rCDI, most notably in patients with multiple recurrences. A systematic approach for evaluating patients with rCDI helps identify patients who benefit most from FMT and those who have other conditions.

Faecal microbiota transplantation for Clostridioides difficile infection: Four years’ experience of the Netherlands Donor Feces Bank

“…18 In particular, new onset or persistent activity of IBD appears to be a diagnostic pitfall. 18,19 In addition, non-responsiveness to anti-CDI…”

Hospitalized Older Patients with Clostridioides difficile Infection Refractory to Conventional Antibiotic Therapy Benefit from Fecal Microbiota Transplant

“…Recurrent CDI, as defined in IDSA guidelines, is defined as an episode of symptom onset and positive C. difficile test result following CDI in the previous 2–8 weeks [ 6 ]. The criteria for FMT in recurrent CDI is the same as that used in our outpatient Complicated C. difficile Clinic (CCDC) [ 16 ]. Briefly, patients were eligible for FMT if they had three or more recurrences of CDI despite appropriate treatments for previous episodes including at least one vancomycin taper [ 16 ].…”

“…The criteria for FMT in recurrent CDI is the same as that used in our outpatient Complicated C. difficile Clinic (CCDC) [ 16 ]. Briefly, patients were eligible for FMT if they had three or more recurrences of CDI despite appropriate treatments for previous episodes including at least one vancomycin taper [ 16 ]. Excluded patients included patients with neutropenia (absolute neutrophil count (ANC) < 500), patients who had undergone solid organ or bone marrow transplantation within the prior year, or patients whose primary oncologic or transplant team were not in agreement with FMT.…”

“…FMT procedure was similar as the procedure described in Shin et al [ 16 ] for outpatient FMT in the Complicated C. difficile Clinic. Briefly, universal donor specimens were prescreened and purchased from OpenBiome (Boston, MA, USA).…”

“…It is therefore of great interest to the clinician treating CDI to study the safety and efficacy of FMT for refractory CDI, especially in the context of older age. Our institution has adopted FMT as treatment for recurrent CDI in the outpatient setting in our Complicated C. difficile Clinic (CCDC) [ 16 ]. For patients admitted to the hospital, selected patients with CDI were treated with FMT, either for recurrent or refractory disease.…”