Durability and Long-term Clinical Outcomes of FMT Treatment in Patients with Recurrent CDI

Fecal microbiota transplant (FMT) appears safe and effective for treatment of recurrent Clostridium difficile infection (RCDI). However, durability, long-term clinical outcomes, and patient satisfaction after FMT are not well described. Eligible patients who received FMT for RCDI at Emory Hospital between 1 July 2012 and 31 December 2016 were contacted via telephone for a follow-up survey. Of 190 eligible patients, 137 (72%) completed the survey. Median time from last FMT to follow-up was 22 months. Overall, 82% (113/137) of patients at follow-up had no recurrence of C. difficile infection (CDI) post-FMT (non-RCDI group) and 18% (24/137) of patients had CDI post-FMT (RCDI group). Antibiotic exposure for non-CDI infections after FMT was more common in the RCDI group compared to the non-RCDI group (75% vs 38%, P = .0009). Overall, 11% of patients reported improvement or resolution of diagnoses not related to CDI post-FMT, and 33% reported development of a new medical condition or symptom post-FMT. Ninety-five percent of patients (122/128) indicated that they would undergo FMT again, and 70% of these 122 reported that they would prefer FMT to antibiotics as initial treatment if they were to have a CDI recurrence. In this follow-up survey of outcomes after FMT at a median of 22 months follow-up, 82% of patients had durable cure of CDI. Patients with recurrence had more post-FMT antibiotic exposure, underscoring the need for thoughtful antibiotic use and a potential role for prophylactic microbiome enrichment to reduce recurrence.


Summary:


Clostridium difficile infection (CDI) is the most common healthcare- associated infection in the United States, and its rates are rising. Normal gastrointestinal microbiota is disrupted by antibiotics or other healthcare exposures allowing C. difficile to get into the intestines. Current first line treatments for CDI are oral vancomycin or metronidazole. Fecal microbiota transplant (FMT) has emerged as a therapy to treat CDI without the use of antibiotics. However, the long-term efficacy of FMT in reducing RCDI is not well described. As FMT is becoming increasingly used for RCDI, we sought to estimate long-term clinical outcomes of FMT recipients, durability of the procedure, and patient satisfaction.


This was a follow up study of all RCDI patients who underwent FMT at Emory University between July 2012 and December 2016. Patients were contacted via telephone for a follow-up survey. Of the 191 eligible patients, 137 (71.7%) responded to the survey and completed most of the questions.


Overall, 82% of patients at follow-up had no recurrence of CDI post-FMT (non-RCDI group, CDI did not reoccur) and 18% of patients had CDI post-FMT (RCDI group, CDI did reoccur). Non-CDI antibiotic use after FMT was more common in the RCDI group compared to the non-RCDI group (75% vs 38%). Overall, 11% of patients reported improvement or resolution of diagnoses not related to CDI post-FMT, and 33% reported development of a new medical condition or symptom post-FMT. Ninety-five percent of patients (122/128) indicated that they would undergo FMT again, and 70% of these 122 reported that they would prefer FMT to antibiotics as initial treatment if they were to have a CDI recurrence.


In this follow-up survey of outcomes after FMT at a median of 22 months follow-up, 82% of patients had durable cure of CDI. Patients with recurrence had more post-FMT antibiotic exposure, underscoring the value of FMT in avoiding repeated antibiotic administration that can perpetuate intestinal microbial imbalance. This follow-up study has demonstrated that FMT was an effective treatment option. The durability of the procedure was supported by having a maximum disease-free interval of 51 months post-FMT. There were low rates of FMT-related complications and high positive patient perception of the procedure.


Read the full paper at: https://www.ncbi.nlm.nih.gov/pubmed/29272401