Predictors of failure after fecal microbiota transplantation for recurrent Clostridioides difficile infection: a systematic review and meta-analysis

Tariq, Raseen; Hayat, Maham; Pardi, Darrell S.; Khanna, Sahil

doi:10.1007/s10096-021-04163-z

Cited by 25 publications

(25 citation statements)

References 28 publications

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“…The literature is controversial regarding the association between post-FMT relapse risk and the aforementioned risk factors. For example, in a recent meta-analysis, Tariq et al highlighted non-CDI antibiotic medication as a post-FMT relapse risk factor [39], contrary to several other studies [22,40]. We agree with the latter.…”

Section: Forms the Risk Factor Association And Fmt Success Ratessupporting

confidence: 77%

Fecal Microbiota Transplant in Severe and Non-Severe Clostridioides difficile Infection. Is There a Role of FMT in Primary Severe CDI?

Popa

Neamţu

Mihalache

et al. 2021

JCM

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Background: Faecal microbiota transplant (FMT) is a highly effective therapy for recurrent Clostridioides difficile infection (rCDI) with cure rates ranging between 85 and 92%. The FMT role for primary Clostridioides difficile infection (CDI) has yet to be settled because of limited data and small-sample studies presented in the current literature. Our study goals were to report the risk factors and the risk of recurrence after FMT for each CDI episode (first, second, and third) and to explore if there is a role of FMT in primary severe CDI. Methods: We conducted a retrospective study to analyze the clinical characteristics and the outcomes of 96 FMT patients with a prior 10 day course of antibiotic treatment in the medical records, of which 71 patients with recurrent CDI and 25 patients with a primary CDI. Results: The overall primary cure rate in our study was 88.5% and the primary cure rate for the severe forms was 85.7%. The data analysis revealed 5.25%, 15.15%, and 27.3% FMT recurrence rates for primary, secondary, and tertiary severe CDI. The risk of recurrence was significantly associated with FMT after the second and the third CDI severe episodes (p < 0.05), but not with FMT after the first severe CDI episode. Conclusions: This study brings new data in supporting the FMT role in CDI treatment, including the primary severe CDI, however, further prospective and controlled studies on larger cohorts should be performed in this respect.

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Section: Forms the Risk Factor Association And Fmt Success Ratessupporting

confidence: 77%

Fecal Microbiota Transplant in Severe and Non-Severe Clostridioides difficile Infection. Is There a Role of FMT in Primary Severe CDI?

Popa

Neamţu

Mihalache

et al. 2021

JCM

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“…Nevertheless, there are certain risk factors that are emerging as predictors of early or late treatment failure. A recently published study concluded that the use of non-CDI antibiotics, diagnosis of inflammatory bowel disease, severe CDI, poor quality of colonoscopy preparation and inpatient status can predict FMT failure [36]. In our cohort only two patients failed to achieve clinical remission after one or two FMT, while 80% were successfully treated just with one FMT procedure.…”

Section: Discussionmentioning

confidence: 62%

“…In our cohort only two patients failed to achieve clinical remission after one or two FMT, while 80% were successfully treated just with one FMT procedure. Reduced efficacy of FMT could be associated with underlying comorbidities, immunosuppressant drugs, severe CDI, inpatient status, use of non-CDI antibiotics [36][37][38][39]. Previously published data also suggest that initial multiple infusions might increase FMT efficacy [7].…”

Section: Discussionmentioning

confidence: 99%

“…For this reason, bowel preparation was not used because it greatly increases patients' comfort, and we did not observe decreased efficacy in this study. A recent systematic review and meta-analysis identified poor bowel preparation as a risk factor for FMT failure when lower gastrointestinal route was chosen [36]. Further studies are welcome to properly evaluate bowel preparation efficacy for FMT via upper gastrointestinal route.…”

Section: Discussionmentioning

confidence: 99%

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Fecal Microbiome Transplantation for Recurrent Clostridioides difficile Infection: Treatment Efficacy, Short and Long-term Follow-up Results from Consecutive Case Series

Urbonas

Ianiro

Gedgaudas

et al. 2021

JGLD

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Background and Aims: Many studies have shown a high effectiveness of fecal microbiota transplantation (FMT) in treatment of recurrent or refractory Clostridioides difficile infection (CDI). Nevertheless, data on long term outcomes and complications after FMT are still lacking. We aimed to evaluate the efficacy, the peri- procedural safety profile and the long-term efficacy and safety of FMT for recurrent CDI during a median follow up period of 24 months. Methods: Our study included 60 consecutive patients that were treated from 2015 to 2019 for recurrent CDI. In all patients FMT was performed through the nasoenteric tube placed during gastroscopy. Fresh donor feces were used for FMT from unrelated donors. Pre-FMT preparation included CDI treatment with oral vancomycin 500 mg q.i.d. for at least five days and proton pump inhibitor (PPI) administration before FMT. Follow up data included information about recurrent CDI episodes, early and late complications, health status at 3, 12 and 24 months after FMT. Results: FMT was performed for 60 patients (median age 72.5 years) with recurrent CDI. Clinical improvement after the first FMT procedure was observed in 48 patients (80%). Ten of 12 initially non-responding patients had a clinical resolution after a second FMT leading to an increased overall cure rate of 96.7 %. The remaining two patients needed a third FMT with a final overall cure rate of 100%. Nine of 60 patients were under immunosuppressive therapy. Six immunosuppressed patients were in the group of initial responders and the remaining three in the initially non-responder group. We observed a very low rate of adverse events in the short and long-term after FMT. During the first eight weeks after the FMT procedure, the death of three patients occurred, but they were not related to the FMT procedure. Patients were followed up for a median of 20 months, with the range from 12 to 55 months. During the follow-up period no long-term serious adverse events (SAE) were documented. Conclusions: Our study confirms excellent efficacy rates of FMT in the treatment of recurrent CDI. In addition, this study shows that it is possible to avoid short term SAE when FMT is administered via a nasoenteric tube by following a very stringent peri-procedural patient follow-up protocol. Our study also demonstrates good safety with a low rate of long-term adverse events after FMT.

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“…Several systematic reviews and meta-analyses have shown FMT being able to successfully treat recurrent clostridium difficile infection (CDI), with a cure rate of almost 90%. Furthermore, the guidelines indicate FMT to be used in patients with at least two episodes of recurrence, both in mild and severe CDI infections, refractory to initial antibiotic treatment (namely, metronidazole and/or vancomycin) [50,51].…”

Section: Beyond Probiotics: Fecal Microbiota Transplantation (Fmt)mentioning

confidence: 99%

Nutritional Status and the Critically Ill Patient: Gut Microbiota and Immuno-Nutrition in I.C.U. at the Time of SARS-COV 2 Pandemic

Scarpellini¹,

Scarcella

Romanelli³

et al. 2021

Gastroenterology Insights

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Background: Gut microbiota is a complex ecosystem of bacteria, viruses, archaea, protozoa and yeasts in our intestine. It has several functions, including maintaining human body equilibrium. Microbial “dysbiosis” can be responsible for outbreak of local and systemic infections, especially in critically ill patients. Methods: to build a narrative review, we performed a Pubmed, Medline and EMBASE search for English language papers, reviews, meta-analyses, case series and randomized controlled trials (RCTs) by keywords and their associations: critically ill patient; nutrition; gut microbiota; probiotics; gut virome; SARS-COV 2. Results: Over the antibiotic-based “selective decontamination”, potentially responsible for drug-resistant microorganisms development, there is growing interest of scientists and the pharmaceutical industry for pre-, probiotics and their associations as safe and reliable remedies restoring gut microbial “eubiosis”. Very first encouraging evidences link different gut microbiota profiles with SARS-COV 2 disease stage and gravity. Thus, there is frame for a probiotic therapeutic approach of COVID-19. Conclusions: gut microbiota remodulation seems to be a promising and safe therapeutic approach to prevent local and systemic multi-resistant bug infections in the intensive care unit (ICU) patients. This approach deserves more and more attention at the time of SARS-COV 2 pandemic.

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Predictors of failure after fecal microbiota transplantation for recurrent Clostridioides difficile infection: a systematic review and meta-analysis

Cited by 25 publications

References 28 publications

Fecal Microbiota Transplant in Severe and Non-Severe Clostridioides difficile Infection. Is There a Role of FMT in Primary Severe CDI?

Fecal Microbiota Transplant in Severe and Non-Severe Clostridioides difficile Infection. Is There a Role of FMT in Primary Severe CDI?

Fecal Microbiome Transplantation for Recurrent Clostridioides difficile Infection: Treatment Efficacy, Short and Long-term Follow-up Results from Consecutive Case Series

Nutritional Status and the Critically Ill Patient: Gut Microbiota and Immuno-Nutrition in I.C.U. at the Time of SARS-COV 2 Pandemic

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