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Fecal microbiota transplant cleared C. difficile in immunocompromised patients
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Fecal microbiota transplant effectively treated Clostridium difficile in immunocompromised patients without a significant increase in incidence of adverse events, according to recent study data.
Although the multicenter study was retrospective, it “shows that people with significant immunocompromising conditions who have a strong indication for fecal microbiota transplant (FMT) will likely benefit from it without too much in the way of side effects,” Elizabeth L. Hohmann, MD, associate professor of medicine/infectious diseases at Massachusetts General Hospital/Harvard Medical School, told Healio.com.
Elizabeth L. Hohmann
Hohmann and colleagues assessed 80 immunocompromised (IC) patients (mean age of 75 adults, 53 years; 52% men) with recurrent (55%), severe or complicated (34%) or refractory (11%) C. difficile infection (CDI) who underwent FMT. Treated patients were followed for a mean of 11 months, and outcomes were evaluated for CDI cure rate, adverse events (AE) and serious adverse events (SAE) within 12 weeks of therapy. Reasons for IC included IBD (45%), which was evaluated as a subset because of disease factors associated with CDI.
After one FMT, 78% of patients were resolved of CDI, with no recurrence at least 12 weeks after treatment. A second FMT was required in 12 patients, eight of whom were CDI free, resulting in an overall CDI cure rate of 89%. In the IBD subset (n=36), CDI cure rate was 86% after a single FMT, and 94% overall.
AEs occurred in 15% of patients; four were related to FMT, five possibly related and three unrelated. SAEs were observed in 15% of patients, including 10 hospitalizations and two deaths. Incidence among IBD patients was not significantly different than the rest of the cohort.
“There has been worry about transmission of infection from FMT in these patients, and that was not demonstrated here,” Hohmann said. “This is not a ‘freebie’ — there were AEs and hospitalizations because these are sick patients, but cure rates were good and not too far off from what is seen in less sick patients. The paper supports cautious FMT in significantly IC patients with problematic CDI.”
Disclosure: See the study for a full list of relevant financial disclosures.
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