Risk factors and epidemiology of Clostridium difficile infection in hematopoietic stem cell transplant recipients during the peritransplant period

Hematopoietic stem cell transplant (HSCT) recipients represent a high-risk group for developing Clostridium difficile (CD) infection (CDI). We aimed to identify specific risk factors for CDI in an HSCT patient population during the peritransplant period. We performed a case-control study within a cohort of HSCT patients who received a transplant from November 2010 to March 2013. Cases had a clinical presentation compatible with CDI and a positive stool sample Xpert® C. difficile test. Controls were CDI negative and matched on age, gender, and transplant type. Peritransplant period was defined as -30 days or time of stem cell mobilization maneuver to 30 days post transplant in autologous SCT or 90 days post transplant in allogeneic SCT. Of 781 HSCTs performed during the study period, 650 (83.2%) had a stool sample submitted for CD testing. Eight-six (13.2%) cases with CDI were identified. Most of the cases were diagnosed within a week after transplantation (median of 5 days). In adjusted analysis, prior hospitalization (odds ratio [OR]: 2.01, 95% confidence interval [CI] 1.2-3.36), prior cephalosporin administration (OR 2.72, 95% CI: 1.54-4.83), and prior chemotherapy (OR: 3.26, 95% CI: 1.92-5.5) were significantly associated with CDI. Hospitalization, and prior antibiotic and chemotherapy use are risk factors that are not easily modifiable, which emphasizes the need to start investigating preventive or prophylactic strategies in this high-risk population.

https://pubmed.ncbi.nlm.nih.gov/27943501/

Diverticulitis after fecal microbiota transplant for C. difficile infection.

Fecal microbiota transplantation (FMT) has become a cornerstone of the management of recurrent and refractory Clostridium difficile infection (CDI). Although it is safe and tolerable, adverse events have been reported with FMT via colonoscopy. Here we report the first case of diverticulitis occurring after an FMT for the treatment of recurrent CDI.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4795814/

Use of standard donors in fecal microbiotal transplants.

Recurrent Clostridium difficile infection (CDI) is a growing epidemic with high recurrence rates after antibiotic treatment. Because of the limited number of medications available, alternative therapies such as fecal microbiota transplantation (FMT) are being closely studied for their role in the treatment of CDI. A systematic review of 27 case series and case reports has reported a 92% cure rate with the use of FMT for patients with recurrent CDI or pseudomembranous colitis with minimal adverse effects.

https://pubmed.ncbi.nlm.nih.gov/25580765/

Fecal microbiota transplant protocol for clostridium difficile infection.

Fecal microbiota transplant has become more acceptable as a therapeutic for recurrent Clostridium difficile infection. The FDA has an enforcement discretion policy for practitioner's performing this therapy, which includes informed consent for this experimental treatment. This manuscript describes a typical procedure that can be followed that includes the important aspects of this preparation and treatment.

https://pubmed.ncbi.nlm.nih.gov/25805532/

Fecal transplant is as effective and safe in immunocompromised as non-immunocompromised patients for Clostridium difficile.

Clostridium difficile infection (CDI) is a leading cause of nosocomial infection and is associated with significant morbidity and mortality. Immunocompromised (IC) patients are particularly at higher risk. Recurrence rates of up to 60 % have been reported after the third episode despite treatment with antibiotics. Recent published reports of fecal microbiota transplantation (FMT) in the IC population have shed light that the procedure proves to be effective and safe. No studies that compare the efficacy and adverse event rate of FMT between IC and non-IC patients currently exist The aim of our study is to compare the response and serious adverse event (SAE) rates of FMT for recurrent or refractory CDI (RCDI) between IC patients and non-IC patients.

https://pubmed.ncbi.nlm.nih.gov/26410257/

Successful treatment of chronic Pouchitis utilizing fecal microbiota transplantation (FMT): a case report.

Fecal microbiota transplantation (FMT) is a novel therapy to transfer normal intestinal flora from a healthy donor to a patient with a medical condition potentially caused by disrupted homeostasis of intestinal microbiota or dysbiosis. FMT has been widely used in refractory Clostridium difficile infection (CDI) and recently it has gained popularity for treatment of inflammatory bowel disease (IBD). Previous studies suggested that manipulating the composition of intestinal flora through antibiotics, probiotics, and prebiotic achieved significant results for treating acute episodes of UC-associated pouchitis. However, currently there is no established effective treatment for chronic antibiotic-dependent or refractory pouchitis. In this report, we described a case of chronic antibiotic refractory pouchitis successfully treated with FMT through pouchoscopy. The effect has been sustainable at 6 months post-FMT.

https://pubmed.ncbi.nlm.nih.gov/26525055/

Intestinal microbiome disruption in patients in a long-term acute care hospital: A case for development of microbiome disruption indices to improve infection prevention.

Long-term acute care hospital (LTACH) patients are a population with high antibiotic consumption,14 likely leading to severe intestinal microbiota disruption. In an effort to make a case for the potential impact of MDIs in improving infection control, we describe and compare the microbiomes from LTACH patients with prior antibiotic exposure, when individuals are most susceptible to MDRO colonization, to those of fecal microbiota transplant donors from a small pilot study, described below. We also examine associations between intestinal microbiome diversity, and clinical and demographic characteristics.

https://pubmed.ncbi.nlm.nih.gov/26905790/

Effects of Fecal Microbial Transplantation on Microbiome and Immunity in Simian Immunodeficiency Virus-Infected Macaques.

An altered intestinal microbiome during chronic human immunodeficiency virus (HIV) infection is associated with mucosal dysfunction, inflammation, and disease progression. We performed a preclinical evaluation of the safety and efficacy of fecal microbiota transplantation (FMT) as a potential therapeutic in HIV-infected individuals. Antiretroviral-treated, chronically simian immunodeficiency virus (SIV)-infected rhesus macaques received antibiotics followed by FMT. The greatest microbiota shift was observed after antibiotic treatment. The bacterial community composition at 2 weeks post-FMT resembled the pre-FMT community structure, although differences in the abundances of minor bacterial populations remained. Immunologically, we observed significant increases in the number of peripheral Th17 and Th22 cells and reduced CD4(+) T cell activation in gastrointestinal tissues post-FMT. Importantly, the transplant was well tolerated with no negative clinical side effects. Although this pilot study did not control for the differential contributions of antibiotic treatment and FMT to the observed results, the data suggest that FMT may have beneficial effects that should be further evaluated in larger studies.

https://pubmed.ncbi.nlm.nih.gov/26937040/

Fecal microbiota transplant for Clostridium difficile infection in older adults.

The objective of this study was to describe the safety of fecal microbiota transplant (FMT) for Clostridium difficile infection (CDI) among older adults. We performed a case review of all FMT recipients aged 65 or older treated at Emory University Hospital, a tertiary care and referral center for Georgia and surrounding states. We found that FMT is a generally safe and effective treatment option for older adults with CDI.

https://pubmed.ncbi.nlm.nih.gov/27134658/

Laboratory Testing of Donors and Stool Samples for Fecal Microbiota Transplantation for Recurrent Clostridium difficile Infection.

Fecal microbiota transplantation is an efficacious and inexpensive therapy for recurrent Clostridium difficile infection, yet its safety is thought to depend on appropriate fecal donor screening. FDA guidance for regulation of this procedure is in flux, but screening and manufacture of fecal material from asymptomatic donors present many challenges to clinical laboratories. This minireview summarizes FDA regulatory changes, principles of donor selection, and recommended laboratory screening practices for fecal microbiota transplantation.

https://pubmed.ncbi.nlm.nih.gov/28077694/

Challenges in fecal donor selection and screening for fecal microbiota transplantation: A review.

Fecal microbiota transplantation is best understood as an effective and inexpensive therapy for recurrent Clostridium difficile infection but fecal donor selection and screening should be periodically revised. Here, we review current recommendations for selection and screening of fecal donors for fecal microbiota transplantation. We recommend considering diabetes mellitus, prior cardiovascular events, and clinical healthcare exposure as fecal donor exclusion criteria until more is known about the association of these conditions with the human gut microbiome. We review the non-bacterial members of the human gut microbiome, associations of the gut microbiome with colorectal malignancies, the human gut resistome and how these may impact future donor screening recommendations. Collaboration between clinicians, clinical laboratory scientists, industry and regulatory agencies will be critically important for continued improvement in donor selection and screening.

https://pubmed.ncbi.nlm.nih.gov/28129018/

Fecal Microbiota Transplant for Clostridium difficile Infection in a Pregnant Patient.

Clostridium difficile infection has been associated with negative outcomes in the general population and in pregnant patients. Fecal microbiota transplant has become the standard for treatment of recurrent as well as refractory C difficile infection. We present a case of a 28-year-old pregnant woman who presented with recurrent C difficile infection despite treatment with vancomycin and fidaxomicin and underwent a successful fecal microbiota transplant through colonoscopy at 18 weeks of gestation. She no longer required antibiotics for the remainder of her pregnancy to treat C difficile and had a term vaginal delivery at 39 weeks of gestation. Our pregnant patient tolerated and responded to a fecal microbiota transplant for treatment of recurrent C difficile infection. Future large-scale studies are needed to determine the efficacy, safety, and long-term effects of manipulating the microbiome in pregnant patients and the neonates.

https://pubmed.ncbi.nlm.nih.gov/28178052/