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Fecal transplant safe, effective for recurrent C. difficile in IBD
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Researchers have demonstrated the safety and efficacy of fecal microbiota transplantation for the treatment of recurrent or refractory Clostridium difficile infection in patients with inflammatory bowel disease.
Results from the retrospective, multicenter cohort study also showed that, in addition to a high overall CDI cure rate, a significant proportion of patients experienced clinical improvement of their IBD after FMT.
Monika Fischer
“Questions surrounding the safety and efficacy of FMT in the IBD and immunocompromised patients with CDI persist,” Monika Fischer, MD, from Indiana University, and colleagues wrote. “Recently published guidelines recommended avoidance of FMT because of the potential infection in an immunosuppressed population and disease exacerbation by FMT.”
Using data from eight academic centers in the U.S., Canada and Europe, the researchers assessed 67 patients with IBD — 52% with Crohn’s disease, 46% with ulcerative colitis and 64% on immunosuppressants — who received FMT via colonoscopy or sigmoidoscopy for recurrent or refractory CDI between 2010 and 2015. They evaluated for CDI recurrence, IBD activity and adverse events occurring within 3 months after the procedure (mean follow-up, 10.4 months).
First FMT was successful in 79% of patients, and the overall success rate was 90% after repeat FMT in the remaining patients.
Moreover, IBD clinical outcome improved in 46.3% of patients 3 months after FMT, remained unchanged in 35.8% and worsened in 17.9%.
Serious adverse events occurred in 12% of patients during the follow-up period. Colectomy for refractory IBD was required in one patient; two patients were hospitalized for CDI; two were hospitalized for IBD exacerbation; one was hospitalized for small bowel obstruction; one was hospitalized for CMV colitis; and one was hospitalized for pancreatitis. Other adverse events included upper respiratory tract infections in four patients, and an IBD flare in another patient.
“Most of the serious [adverse events] were not directly attributable to FMT except for CMV, which can be transmitted through stool,” the researchers wrote.
They concluded that “FMT is highly effective and safe for eradicating recurrent or refractory CDI in patients with IBD, similar to what has been reported in those without IBD. The effect of FMT on IBD disease activity is not predictable, and therefore, it is still unknown exactly where FMT fits in the treatment paradigm for these patients.”
However, as poor IBD outcomes are associated with CDI, “FMT should be considered early on in this population,” they added. – by Adam Leitenberger
Disclosures: The researchers report no relevant financial disclosures.
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