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. CDI resolved in 27 (87%) of 31 respondents, including three individuals who received multiple FMTs. Among four whose CDI was not resolved at follow up, three respondents did well initially before CDI recurred, and one individual never eradicated his CDI despite repeating FMT. During the study, five deaths and eight serious adverse events requiring hospitalization were reported within the study group during the follow-up period. Fecal transplant was not a causative factor in these events. The most common adverse event reported in 4 (13%) of 31 respondents was subjective worsening of arthritis. FMT is a generally safe and effective treatment option for older adults with CDI.


Summary:


Clostridium difficile infection (CDI) is a diarrheal disease with a high burden or morbidity and mortality in the United States. C. difficile can be present in small numbers in a healthy human gut. However, when the intestinal ecosystem is disrupted by exposure to antibiotics and other factors, C. difficile can take over and cause acute inflammatory diarrhea and in severe cases cause pseudomembranous colitis. It is frequently treated with antibiotics, yet some individuals remain vulnerable to CDI recurrence. Compared to younger adults, older adults suffer increased morbidity and mortality from CDI, increased rates of CDI recurrence, and antibiotic treatment failure.


Fecal microbiota transplant (FMT) is an emerging therapy for CDI by restoring a healthy microbiota in the gut. An FMT is an infusion of feces from a healthy donor into the recipient’s gastrointestinal (GI) tract.


A follow-up study was performed on all FMT recipients of 65 years of age or older who were treated for CDI since 2012. The purpose was to describe our experience treating older adults with FMT for CDI. The FMTs were performed in both inpatient and outpatient settings using a variety of infusion methods. Follow up data was collected from speaking with patients or their caregivers. The outcomes measured were resolution of CDI, adverse events, significant adverse effects, and death.


Between July 2012 and April 2014, 31 individuals with recurrent CDI received FMTs and were 65 or older. CDI was resolved in 27 (87%) of 31 individuals. 24 individuals CDI was resolved after a single FMT, while 3 others CDI was resolved after multiple FMTs. Among four whose CDI was not resolved at follow up, three respondents did well initially before CDI recurred, and one individual never eradicated his CDI despite repeating FMT.


During the study, five deaths and eight major health events were reported in the study group, and none of which were attributed to FMT. The most common adverse event reported in 4 (13%) of 31 respondents was subjective worsening of arthritis.


This case series presents evidence that FMT is a safe and effective treatment for CDI in older adults. Our rates of resolution were much higher in patients receiving a colonoscopy FMT (92%) than postpyloric FMT (30%). A higher resolution rate was seen in outpatient settings versus inpatient setting (94% versus 42% resolution). Based on our data, we recommend FMT as an effective treatment for older adults with recurrent CDI who meet the criteria for colonoscopy in the outpatient setting. An FMT performed in this manner produces excellent outcomes with low risk.


Read the full paper at https://www.ncbi.nlm.nih.gov/pubmed/27134658