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Researchers identify predictors of FMT failure for C. difficile infection

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HONOLULU — Factors associated with failure of fecal microbiota transplantation for patients with Clostridium difficile infection include being an inpatient during the procedure, being immunosuppressed and having prior hospitalizations related to C. difficile infection, according to data presented at ACG 2015.

“Collective evidence demonstrates that fecal transplant is a highly efficacious therapy for recurrent and refractory C. diff. However, 10% to 20% of the patients fail this therapeutic modality,” Monika Fischer, MD, MSc, from the department of medicine at Indiana University, said during her presentation. “Factors associated with FMT failure are currently not known.”

Monika Fischer

Colleen R. Kelly

In collaboration with Colleen R. Kelly, MD, FACG, and colleagues from Brown University, Fischer and colleagues aimed to identify clinical predictors of FMT failure after a single fecal transplant for the treatment of C. difficile infection (CDI).

They reviewed electronic medical records for 345 patients (71.8% female; mean age, 61.9 ± 19.1 years; 24% immunosuppressed; 16.7% inpatient) who underwent FMT between 2011 and 2015 at two tertiary referral centers. The investigators included demographics, patient characteristics, clinical variables and FMT outcomes in their analysis, with FMT success defined as complete resolution of symptoms and/or a negative C. difficile polymerase chain reaction test 3 months after FMT without need for further treatment.

The overall FMT failure rate at 3 months was 23.7%. Multivariate analysis showed risk factors associated with risk for FMT failure at 3 months included inpatient status during FMT (OR = 6.9; 95% CI, 2.9-16.3), immunosuppressed state (OR = 3.5; 95% CI, 1.7-2.8) and prior hospitalization related to CDI (OR = 1.45; 95% CI, 1.2-1.8), with the risk for failure increasing by 45% with each additional hospitalization.

Fischer and colleagues then developed patient risk scores and stratified them into low, moderate and high risk groups, with failure rates of 12.8%, 17.1% and 43.8% for each group, respectively.

“We also found that risk of FMT failure is predictable based upon pre-FMT data, and we hope that physicians will find the proposed risk stratification model helpful when planning and discussing an FMT with their patients,” Fischer said. – by Adam Leitenberger 

Reference:

Fischer M, et al. Abstract 39. Presented at: ACG 2015; Oct. 19-21, 2015; Honolulu, HI.

Disclosures: Fischer reports she is an advisory board member for Rebiotix. Kelly reports she is a consultant and site investigator for SeresHealth and has received research support from Assembly Biosciences.