C. difficile infection recurrence after FMT higher than previously reported in IBD
CHICAGO — More than 20% of patients with inflammatory bowel disease experienced recurrent Clostridioides difficile infection 1 year after fecal microbiota transplantation, according to data presented at Digestive Disease Week.
“While there are data on the short-term efficacy of FMT for eradicating C. diff infections in patients with IBD, there is less known about longer-term outcomes,” Edward V. Loftus Jr., MD, the Maxine and Jack Zarrow Family Professor of Gastroenterology at the Mayo Clinic, told Healio. “We assessed our experience with longer follow-up time, focused our attention on patients with moderate to severe colonic IBD activity and found that the recurrence rate of C. diff infection was higher than previously reported, and that about one-third of patients ultimately required colectomy.”
Aiming to assess durability of FMT in patients with moderate to severe IBD, Loftus and colleagues conducted a retrospective study of 53 patients with IBD (median duration, 6 years; 36 ulcerative colitis; 14 ileocolonic Crohn’s disease; 3 indeterminate colitis) who were undergoing FMT via colonoscopy for recurrent C. difficile infection.
Researchers collected data on demographics, IBD and recurrent C. difficile infection history and post-FMT outcomes. Durability of FMT, which was defined being free from C. difficile infection recurrence at the 1-year follow-up, served as the primary outcome. Other outcomes included adverse events from FMT and colectomy rate.
According to researchers, 20 patients had moderate endoscopic severity when FMT was performed and 33 had severe. Before FMT, the median number of C. difficile infection episodes was three, with recurrent C. difficile infection reported in 12 patients through the 1-year follow-up. The overall durable response was 74.4% (95% CI, 68.9-88).
Of the 12 patients with recurrence following the first FMT, 10 repeated the procedure and two were treated with antibiotics. Seven participants had an IBD flare, of whom two needed an emergency visit and one needed a colectomy; the remaining 46 patients reported no adverse events.
Loftus and colleagues noted 75% of patients had ongoing IBD flare at the time of FMT, with 80% continuing to flare after the procedure. Following FMT, 11.3% of participants experienced improvement in symptoms and 9% had a new flare. Notably, 84% had escalation of IBD therapy, but even with this, 38% required colectomy within a maximum follow-up of 8.2 years.
Univariate analysis also demonstrated that C. difficile infection after FMT was an independent predictor of colectomy risk (HR = 2.96; 95% CI, 1.04-8.46).
Loftus added, “The next step would be to investigate whether other microbial-derived therapies could decrease the colectomy rate in these [IBD-C. difficile infection] patients.”
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Tariq R, et al. Poster 1871: Durability and outcomes of fecal microbiota transplantation for recurrent C. difficile infection in patients with moderate to severe inflammatory bowel disease. Presented at: Digestive Disease Week; May 5-9, 2023; Chicago (hybrid meeting).
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