Risk of Clostridium difficile Infection with Systemic Antimicrobial Therapy Following Successful Fecal Microbiota Transplant: Should We Recommend Anti-Clostridium difficile Antibiotic Prophylaxis?

Allegretti, Jessica R.; Kao, Dina; Phelps, Emmalee; Roach, Brandi; Smith, Justin D.; Ganapini, Vincent; Kassam, Zain; Xu, Huiping; Fischer, Monika

doi:10.1007/s10620-018-5450-4

Cited by 24 publications

(11 citation statements)

References 11 publications

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“…22,23 Moreover, a multi-center study demonstrated that use of probiotics after successful FMT was associated with CDI recurrence. 24 These studies, along with the IDSA guideline's statement that there is insufficient evidence to recommend probiotics for primary prevention of CDI, suggests that probiotics should be avoided in patients with cirrhosis.…”

Section: Discussionmentioning

confidence: 99%

Fecal Microbiota Transplantation Is Safe and Effective in Patients With Clostridioides difficile Infection and Cirrhosis

Cheng

Alhaffar

Saha

et al. 2021

Clinical Gastroenterology and Hepatology

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Section: Discussionmentioning

confidence: 99%

Fecal Microbiota Transplantation Is Safe and Effective in Patients With Clostridioides difficile Infection and Cirrhosis

Cheng

Alhaffar

Saha

et al. 2021

Clinical Gastroenterology and Hepatology

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“…We focused these initial studies on the early post-treatment events because the clinical efficacy of FMT in breaking the cycle of CDI recurrence is typically assessed at ∼2 months following treatment. However, a substantial fraction of rCDI patients treated with FMT remain vulnerable to CDI relapse with new antibiotic provocations (19, 20), an observation that raises concerns about the stability and resilience of the post-FMT microbiota. While we observed that the donor bacterial engraftment was stable through a 2-month follow-up time point, the extent of sustained, longer-term engraftment has thus far not been evaluated.…”

Section: Introductionmentioning

confidence: 99%

Durable Long-Term Bacterial Engraftment following Encapsulated Fecal Microbiota Transplantation To Treat Clostridium difficile Infection

Staley

Kaiser

Vaughn

et al. 2019

mBio

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Fecal microbiota transplantation (FMT) has become a common rescue therapy for recurrent Clostridium difficile infection, and encapsulated delivery (cFMT) of healthy donor microbiota shows similar clinical efficacy as more traditional routes of administration. In this study, we characterized long-term patterns of bacterial engraftment in a cohort of 18 patients, who received capsules from one of three donors, up to 409 days post-FMT. Bacterial communities were characterized using Illumina sequencing of the V5-V6 hypervariable regions of the 16S rRNA gene, and engraftment was determined by using the Bayesian algorithm SourceTracker. All patients recovered clinically and were free of C. difficile infection following cFMT. The majority of patients (61%) showed high levels of engraftment after the first week following FMT, which were sustained throughout the year. A small subset, 22%, experienced a decline in donor engraftment after approximately 1 month, and a few patients (17%), two of whom were taking metformin, showed delayed and low levels of donor engraftment. Members of the genera Bacteroides, Parabacteroides, and Faecalibacterium were significantly and positively correlated with donor similarity (ρ = 0.237 to 0.373, P ≤ 0.017). Furthermore, throughout the year, patient fecal communities showed significant separation based on the donor fecal microbiota that they received (P < 0.001). Results of this study, which characterize long-term engraftment following cFMT, suggest that numerical donor similarity is not strictly related to clinical outcome and identify a persistent donor-specific effect on patient fecal microbial communities. Furthermore, results suggest that members of the Bacteroidetes may be important targets to improve engraftment via cFMT. IMPORTANCE Recurrent Clostridium difficile infection (rCDI) is the most common cause of hospital- and community-acquired diarrheal infection associated with antibiotic use. Fecal microbiota transplantation (FMT), a treatment that involves administration of fecal bacteria from a healthy donor to a recipient patient, is a highly effective rescue therapy for rCDI that is increasingly being incorporated into standard clinical practice. Encapsulated, freeze-dried preparations of fecal microbiota, administered orally, offer the simplest and most convenient route of FMT delivery for patients (cFMT). In this study, we evaluated the extent of bacterial engraftment following cFMT and the duration of donor bacterial persistence. All patients studied recovered clinically but showed differing patterns in long-term microbial community similarity to the donor that were associated with members of the bacterial group Bacteroidetes, previously shown to be prominent contributors to rCDI resistance. Results highlight long-lasting, donor-specific effects on recipient patient microbiota and reveal potential bacterial targets to improve cFMT engraftment.

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“…However, there was no difference in those who received concomitant CDI prophylaxis versus those who did not. 67 In this latter study, those who received preventive probiotics actually had a higher risk for rCDI. Similar data looking at the primary role of oral probiotics (Bio-K+ - Lactobacillus acidophilus CL1285, L. casei LBC80R, and L. rhamnosus CLR2) failed to reduce hospital-onset CDI in a practical study of over 1500 patients.…”

Section: Fecal Microbiota Transplantationmentioning

confidence: 84%

Clostridioides difficile therapeutics: guidelines and beyond

Orenstein

Patron

2019

Therapeutic Advances in Infection

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Clostridioides difficile infection (CDI) has become an increasingly common infection both within and outside of the hospital setting. The management of this infection has been evolving as we learn more about the role of the human microbiota in protecting us from this gastrointestinal opportunist. For many years the focus of treatment had been on eradication of the vegetative, toxin-producing form of the organism, with little regard for its collateral impact on the host’s microbiota or risk of recurrence. With the marked increase in C. difficile disease, and, particularly, recurrent disease in the last decade, new guidelines are more focused on targeting and reducing collateral damage to the colonic microbiota. Immune-based strategies that manipulate the microbiota and provide a humoral response to toxins have now become mainstream. Newer strategies are needed to look beyond simply resolving the primary episode but are focused on delayed outcomes such as cure at 90 days, reduced morbidity and mortality, and patient quality of life. The purpose of this review is to familiarize readers with the most recent evidence-based guidelines for C. difficile management, and to describe the role of newer antimicrobials, immunological-, and microbiota-based therapeutics to prevent recurrence and improve the outcomes of people with CDI.

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Risk of Clostridium difficile Infection with Systemic Antimicrobial Therapy Following Successful Fecal Microbiota Transplant: Should We Recommend Anti-Clostridium difficile Antibiotic Prophylaxis?

Cited by 24 publications

References 11 publications

Fecal Microbiota Transplantation Is Safe and Effective in Patients With Clostridioides difficile Infection and Cirrhosis

Fecal Microbiota Transplantation Is Safe and Effective in Patients With Clostridioides difficile Infection and Cirrhosis

Durable Long-Term Bacterial Engraftment following Encapsulated Fecal Microbiota Transplantation To Treat Clostridium difficile Infection

Clostridioides difficile therapeutics: guidelines and beyond

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