Patient Perspectives on Fecal Microbiota Transplantation for Clostridium Difficile Infection

Zellmer, Caroline; Wolfe, Travis J. De; Hoof, Sarah Van; Blakney, Rebekah; Safdar, Nasia

doi:10.1007/s40121-016-0106-1

Cited by 20 publications

(53 citation statements)

References 22 publications

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“…The FMT procedure is very well tolerated by patients, with up to 97% of recipients being willing to repeat treatment if needed. [ 29 83 ] In our experience, adverse events associated with FMT are usually mild and self-limited. Abdominal pain, loose stools, and dizziness constituted the most common complaints, largely consistent with the previously published data.…”

Section: Discussionmentioning

confidence: 93%

Early results of fecal microbial transplantation protocol implementation at a community-based university hospital

Duarte-Chavez

Wojda

Zanders

et al. 2018

J Global Infect Dis

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Introduction:Clostridium difficile (CD) is a serious and increasingly prevalent healthcare-associated infection. The pathogenesis of CD infection (CDI) involves the acquisition of CD with a concurrent disruption of the native gut flora. Antibiotics are a major risk although other contributing factors have also been identified. Clinical management combines discontinuation of the offending antibiotic, initiation of CD-specific antibiotic therapy, probiotic agent use, fecal microbiota transplantation (FMT), and surgery as the “last resort” option. The aim of this study is to review short-term clinical results following the implementation of FMT protocol (FMTP) at our community-based university hospital.Methods:After obtaining Institutional Review Board and Infection Control Committee approvals, we implemented an institution-wide FMTP for patients diagnosed with CDI. Prospective tracking of all patients receiving FMT between July 1, 2015, and February 1, 2017, was conducted using REDCap™ electronic data capture system. According to the FMTP, indications for FMT included (a) three or more CDI recurrences, (b) two or more hospital admissions with severe CDI, or (c) first episode of complicated CDI (CCDI). Risk factors for initial infection and for treatment failure were assessed. Patients were followed for at least 3 months to monitor for cure/failure, relapse, and side effects. Frozen 250 mL FMT samples were acquired from OpenBiome (Somerville, MA, USA). After 4 h of thawing, the liquid suspension was applied using colonoscopy, beginning with terminal ileum and proceeding distally toward mid-transverse colon. Monitored clinical parameters included disease severity (Hines VA CDI Severity Score or HVCSS), concomitant medications, number of FMT treatments, non-FMT therapies, cure rates, and mortality. Descriptive statistics were utilized to outline the study results.Results:A total of 35 patients (mean age 58.5 years, 69% female) were analyzed, with FMT-attributable primary cure achieved in 30/35 (86%) cases. Within this subgroup, 2/30 (6.7%) patients recurred and were subsequently cured with long-term oral vancomycin. Among five primary FMT failures (14% total sample), 3 (60%) achieved medical cure with long-term oral vancomycin therapy and 2 (40%) required colectomy. For the seven patients who either failed FMT or recurred, long-term vancomycin therapy was curative in all but two cases. For patients with severe CDI (HVCSS ≥3), primary and overall cure rates were 6/10 (60%) and 8/10 (80%), respectively. Patients with CCDI (n = 4) had higher HVCSS (4 vs. 3) and a mortality of 25%. Characteristics of patients who failed initial FMT included older age (70 vs. 57 years), female sex (80% vs. 67%), severe CDI (80% vs. 13%), and active opioid use during the initial infection (60% vs. 37%) and at the time of FMT (60% vs. 27%). The most commonly reported side effect of FMT was loose stools.Conclusions:This pilot study supports the efficacy and safety of FMT administration for CDI in the setting of a community-based university ho...

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Section: Discussionmentioning

confidence: 93%

Early results of fecal microbial transplantation protocol implementation at a community-based university hospital

Duarte-Chavez

Wojda

Zanders

et al. 2018

J Global Infect Dis

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“…While patient aversion to the aesthetics of FMT is cited by clinicians as a barrier to its use, 33 in a large survey of 192 patients, when provided with efficacy data for CDI treatments, 85% of patients chose FMT, with only 4% deterred by its fecal composition. 34 Furthermore, high symptom burden and morbidity has been shown to be a powerful motivator for acceptance of FMT as a treatment, 35 and high patient satisfaction has previously been reported. 13 Awareness of this therapy seems to be increasing over time, with a third of patients in this cohort first hearing of FMT through the media, as opposed to their general practitioner or medical specialist.…”

Section: Discussionmentioning

confidence: 99%

Physician and patient perceptions of fecal microbiota transplant for recurrent or refractory Clostridioides difficile in the first 6 years of a central stool bank

et al. 2020

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Background and Aim: Fecal microbiota transplantation (FMT) is a highly effective therapy for recurrent or refractory Clostridioides difficile infection (rCDI). Despite inclusion in society guidelines, the uptake of FMT therapy has been variable. Physician and patient attitudes may be a barrier to evidence-based uptake of therapies; however, data assessing attitudes regarding FMT for rCDI are limited. Methods: The South Australian FMT for CDI database prospectively recorded patient outcomes of FMT for CDI from August 2013 to January 2019. A total of 93 consecutive patients who underwent FMT for rCDI in South Australia were invited to participate in a 20-question survey regarding the patient experience of FMT. All gastroenterologists and infectious disease physicians practicing in South Australia were invited to participate in an online survey comprised of 22 questions that addressed referral experience, indications for referral, perceived risks, and regulation and funding. Results: Fifty-four patients (54/93, 58%) returned the survey, of whom 52 (96%) would recommend FMT to others, and 51 (94%) were satisfied with treatment outcome. Fifty physicians returned the online survey (50/100, 50%), of whom 23 (46%) were concerned about disease transmission risk, and 15 (30%) believed that the risk of FMT would outweigh the benefit. Infectious diseases physicians and advanced trainees had significantly greater concern regarding the potential alteration of the microbiome than gastroenterology physicians and advanced trainees (8/17 (47%) vs 6/ 33 (18%); P = 0.047). Conclusion: Despite high levels of patient-reported satisfaction following FMT, physician-reported reservations exist and may present a barrier to uptake of this therapy.

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“…Specifically, probiotics were associated with a delay to both the onset of primary CDI and CDI relapse. Due to the significant extent to which CDI can contribute to patients' social, physical, and emotional anxiety, and subsequently their overall quality of life, a delay to symptomatic onset from C. difficile inoculation time can have significant translational application (33). Together, the evidence from these studies suggests the multistrain probiotic may have promise in preventing outcomes associated with CDI.…”

Section: Discussionmentioning

confidence: 99%

Modified Mouse Model of Clostridioides difficile Infection as a Platform for Probiotic Efficacy Studies

Wolfe

Kates

Barko

et al. 2019

Antimicrob Agents Chemother

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Probiotics may represent a promising approach for reducing Clostridioides (Clostridium) difficile infections (CDIs). A clinical trial conducted by our group demonstrated that CDI patients undergoing adjunctive treatment with Lactobacillus and Bifidobacterium probiotics had a reduction in diarrheal duration and compositional changes in their stool microbiomes. Here, we modified a CDI mouse model to represent clinical outcomes observed in patients and employed this model to identify evidence for the prevention of primary CDI and relapse with the same probiotic. Mice (n = 80) were administered 0.25 mg/ml cefoperazone over 5 days and subsequently challenged with 102 C. difficile VPI 10463 spores. A subset of mice (n = 40) were administered 108 CFU of probiotics daily alongside cefoperazone pretreatment and until experimental endpoints were reached. Clinical scoring was performed daily on mice and used to evaluate CDI onset and severity. Moderate CDI in mice was defined by survival beyond day 3 postinfection, while mice with severe CDI were those who succumbed to infection prior to day 3 postinfection. Sequencing and analysis of 16S rRNA from stool content were performed to determine compositional alterations to the microbiota. Using total clinical scores, we identified an association between probiotic treatment and delayed onset of primary CDI and relapse by approximately 12 to 24 h (P < 0.001). The stool microbiome of mice with moderate CDI receiving probiotic treatment was significantly enriched with Lachnospiraceae during primary CDI (P < 0.05). The outcomes observed present an opportunity to use this modified CDI mouse model to examine the efficacy of nonantibiotic options for CDI management.

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Patient Perspectives on Fecal Microbiota Transplantation for Clostridium Difficile Infection

Cited by 20 publications

References 22 publications

Early results of fecal microbial transplantation protocol implementation at a community-based university hospital

Early results of fecal microbial transplantation protocol implementation at a community-based university hospital

Physician and patient perceptions of fecal microbiota transplant for recurrent or refractory Clostridioides difficile in the first 6 years of a central stool bank

Modified Mouse Model of Clostridioides difficile Infection as a Platform for Probiotic Efficacy Studies

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