Treatment of Recurrent Clostridium Difficile Infection using Fecal Microbiota Transplantation in Patients with Inflammatory Bowel Disease

Newman, Krista M.; Rank, Kevin; Vaughn, Byron P.; Khoruts, Alexander

doi:10.1016/s0016-5085(17)31409-9

Cited by 25 publications

(38 citation statements)

References 5 publications

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“…6 However, our results indicate that there is a non-trivial late recurrence that occurs between 2 and 6 months (18.5% versus 37.3% recurrence) post FMT. Underlying IBD has been proposed as a risk factor for late recurrence of CDI, 14 but in our cohort we found no difference in recurrent CDI at 6 months between IBD and non-IBD patients. Identified risk factors for CDI recurrence after FMT have included severe CDI, inpatient status, the number of previous CDIs and a low albumin at the time of FMT.…”

Section: Discussioncontrasting

confidence: 88%

Microbial Engraftment and Efficacy of Fecal Microbiota Transplant for Clostridium difficile Patients With and Without IBD

Hirten

Grinspan

et al. 2018

Preprint

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Background & AimsRecurrent and refractory Clostridium difficile infections (CDI) are effectively treated with fecal microbiota transplant (FMT). Uncertainty exists regarding the effectiveness of FMT for CDI with underlying inflammatory bowel disease (IBD), its effects on disease activity and its effectiveness transferring the donor microbiome to patients with and without IBD. This study aims to determine FMTs effectiveness in subjects with and without IBD, its impact on IBD activity, the level of microbiome engraftment, and predictors of CDI recurrence.MethodsSubjects with and without IBD who underwent FMT for recurrent or refractory CDI between 2013 and 2016 at The Mount Sinai Hospital were followed for up to 6 months. The primary outcome was CDI recurrence 6 months after FMT. Secondary outcomes were (1) CDI recurrence 2 months after FMT; (2) Frequency of IBD flare after FMT; (3) Microbiome engraftment after FMT; (4) Predictors of CDI recurrence.ResultsOverall, 134 patients, 46 with IBD, were treated with FMT. There was no difference in recurrence in patients with and without IBD at 2 months (22.5% vs 17.9%; p=0.63) and 6 months (38.7% vs 36.5%; p>0.99). Proton pump inhibitor use, severe CDI, and comorbid conditions were predictors of recurrence. The pre-FMT microbiome was not predictive of CDI recurrence. Subjects with active disease requiring medication escalation had reduced engraftment. There was no difference in engraftment based on IBD endoscopic severity at FMT.ConclusionsIBD did not affect CDI recurrence rates 6 months after FMT. Pre-FMT microbiome was not predictive of recurrence, and microbial engraftment was dependent on IBD treatment escalation but not on underlying disease severity.

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Section: Discussioncontrasting

confidence: 88%

Microbial Engraftment and Efficacy of Fecal Microbiota Transplant for Clostridium difficile Patients With and Without IBD

Hirten

Grinspan

et al. 2018

Preprint

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“…The heterogeneous population consisted of both inpatients and outpatients, with CDI ranging from mild to moderate, to more severe and severe complicated infections. They compared post-FMT outcomes in these IBD patients to outcomes of non-IBD patients who had undergone FMT for the same indication, reporting that the failure rate after FMT did not differ between patients with and without IBD, which differs from other published experience in which patients with IBD fail FMT more frequently [9,11]. Furthermore, no complications secondary to FMT were reported, results in keeping with the published experience of other FMT centers [9,12].…”

supporting

confidence: 56%

“…The authors admit that the degree of IBD severity and previous treatments were unknown in many of these patients when initially evaluated in their tertiary referral center; many were assumed to be stable from an IBD standpoint. Though no disease flares post-FMT were reported in this study, up to half of patients with UC may experience a flare of their disease after FMT [9]. Since patients with more severe inflammation at the time of FMT may be more likely to flare or require intensification of their IBD regimen post-FMT, IBD patients should be counseled about potential disease deterioration as part of the informed consent process.…”

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confidence: 71%

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FMT in IBD: What Have We Learned?

Kelly

Allegretti

2017

Dig Dis Sci

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“…Multiple strategies have been developed to manipulate the composition and structure of the gut microbiota. Fecal Microbiota Transplantation (FMT) has proved to be an effective treatment for individuals with clostridium difficile infection (CDI), inflammatory bowel disease (IBD), and some other gastrointestinal diseases (Browne & Kelly, ; Newman, Rank, Vaughn, & Khoruts, ). However, FMT is not a convenient method for general use and researchers are examining alternative approaches of manipulating the gut microbiota including oral delivery of prebiotics, probiotics, symbiotics, and postbiotics (Aguilar‐Toala et al., ; Petrof & Khoruts, ).…”

Section: Introductionmentioning

confidence: 99%

Progress in microencapsulation of probiotics: A review

Yao

Xie

et al. 2020

Comp Rev Food Sci Food Safe

301

160

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The potential health benefits of probiotics may not be realized because of the substantial reduction in their viability during food storage and gastrointestinal transit. Microencapsulation can be used to enhance the resistance of probiotics to unfavorable conditions. A range of oral delivery systems has been developed to increase the level of probiotics reaching the colon including embedding and coating systems. This review introduces emerging strategies for the microencapsulation of probiotics and highlights the key mechanisms of their stress–tolerance properties. Recent in vitro and in vivo models for evaluation of the efficiency of probiotic delivery systems are also reviewed. Encapsulation technologies are required to maintain the viability of probiotics during storage and within the human gut so as to increase their ability to colonize the colon. These technologies work by protecting the probiotics from harsh environmental conditions, as well as increasing their mucoadhesive properties. Typically, the probiotics are either embedded inside or coated with food‐grade materials such as biopolymers or lipids. In some cases, additional components may be coencapsulated to enhance their viability such as nutrients or protective agents. The importance of having suitable in vitro and in vivo models to evaluate the efficiency of probiotic delivery systems is also emphasized.

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Treatment of Recurrent Clostridium Difficile Infection using Fecal Microbiota Transplantation in Patients with Inflammatory Bowel Disease

Cited by 25 publications

References 5 publications

Microbial Engraftment and Efficacy of Fecal Microbiota Transplant for Clostridium difficile Patients With and Without IBD

Microbial Engraftment and Efficacy of Fecal Microbiota Transplant for Clostridium difficile Patients With and Without IBD

FMT in IBD: What Have We Learned?

Progress in microencapsulation of probiotics: A review

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