Outcomes of Fecal Microbiota Transplantation for C. difficile Infection in Inflammatory Bowel Disease

Abstract

Background: Fecal microbiota transplantation (FMT) is a safe and effective therapy for recurrent Clostridioides difficile infection (CDI). Data on FMT for CDI in patients with underlying inflammatory bowel disease (IBD) are emerging but conflicting. We performed a systematic review and meta-analysis to describe the efficacy and safety of FMT for CDI in IBD and its impact on IBD outcomes. Methods: A systematic search of multiple databases including Embase, Scopus, and Web of Science was performed. Our primary analysis focused on pooled rate of CDI resolution after single and multiple FMTs in IBD patients. Additional analyses included rates of IBD-associated outcomes (flare, surgery, symptom improvement) after FMT. The random-effects model was used to calculate pooled rates. Results: Among 457 adult patients, 363 had CDI resolution after first FMT with a pooled cure rate of 78% [95% confidence interval (CI): 73%-83%; I 2=39%]. Overall pooled rate cure rate with single and multiple FMTs was 88% (95% CI: 81%-94%; I 2=73%). The pooled rate of an IBD flare after FMT was 26.8% (95% CI: 22.5%-31.6%; I 2=9%) and of colectomy was 7.3% (95% CI: 4.7%-10.5%; I 2=56%). Among 141 pediatric patients, 106 had CDI resolution after first FMT with pooled cure rate of 78% (95% CI: 58%-93%; I 2=59%). Overall pooled cure rate with single and multiple FMTs was 77% (95% CI: 50%-96%; I 2=63%). The pooled rate of an IBD flare after FMT was 10.8% (95% CI: 5.7%-18.5% I 2=43%), and of colectomy was 10.3% (95% CI: 2.1%-30.2% I 2=23%). Conclusions: FMT appears to be a highly effective therapy for preventing recurrent CDI in patients with IBD. Patients who fail a single FMT may benefit from multiple FMTs.

Short- and long-term follow-up after fecal microbiota transplantation as treatment for recurrent Clostridioides difficile infection in patients with inflammatory bowel disease

“…The low number of IBD flares encountered in our cohort contrasts with previous studies suggesting exacerbations of IBD after FMT in up to 22% of patients. 19 IBD predisposes to both infection and colonization with C. difficile, probably because of the disturbed microbiota associated with IBD. There are several difficulties related to assessing and treating patients with concomitant IBD and CDI.…”

Fecal Microbiota Transplantation Is Effective for Postcolectomy Recurrent Clostridioides difficile Infection

“…11,12 The majority of our patient population underwent colectomy for IBD, and previous studies have shown that FMT in IBD patients were effective in treating rCDI and did not result in serious adverse events. 13,14 We demonstrated in our study that FMT is safe to perform in patients who have undergone partial or total colectomy with low rates of CDI recurrence post-FMT.…”

Efficacy and Safety of Fecal Microbiota Transplantation in Treatment of Clostridioides difficile Infection among Pediatric Patients: A Systematic Review and Meta-Analysis

“…Some examples include the type of stool received (e.g., fresh versus frozen stools), time from diagnosis of CDI until FMT, severity of CDI or IBD symptoms, mode of delivery, and concomitant medications, among others [1,40]. A systematic review and meta-analysis by Tariq et al concluded that FMT is an effective therapy for rCDI in adult patients with IBD [41]. A similar analysis for pediatric patients has not been completed to the best of our knowledge.…”