Mohamed Abdallah, MD1, Abdelmohaymin Abdalla, MD1, Noah Wiedel, MD2, Brett Baloun, MD1, Jorge Gilbert, MD1
1University of South Dakota Sanford School of Medicine, Sioux Falls, SD; 2University of Nebraska Medical Center, Omaha, NE
Introduction: Clostridioides (formerly Clostridium) difficile infection (CDI) is the most commonly identified cause of healthcare-acquired infections in the united states (US). Fecal microbiota transplantation (FMT) is recommended for patients with three or more episodes of CDI. We aim to examine factors associated with the success of FMT in our institution
Methods: A retrospective study of 59 patients who underwent FMT for CDI at Sanford Medical Center, Sioux Falls SD, the US between 2013-2018. All patients underwent FMT via colonoscopy. Antibiotics prior to FMT, donor screening, preparation and delivery of FMT, and post-procedural follow up were based on a standardized protocol in our institution. Data on baseline characteristics, CDI, safety and success rate of FMT (defined by resolution of symptoms and absence of CDI recurrence at 8 and 52 weeks) were collected
Results: Baseline characteristics of our study population are shown in (Table1). The mean age at FMT was 57 years (19-92 years). There were 96% Caucasians and 76% of females. 40% and 35% had three and four episodes of CDI prior to FMT, respectively. Antibiotics were implicated in CDI development in 80% of subjects, most commonly: penicillins (28.8%), cephalosporins (28.8%) and fluoroquinolones (23.7%). 20% had inflammatory bowel disease (IBD), 47% were on proton pump inhibitors (PPIs), and 22% were on immunosuppressants at the time of FMT. Regarding antibiotics used to treat CDI: 58/59 patients received at least one trial of oral vancomycin (84% had vancomycin with six weeks taper), 72% had oral metronidazole and 15% had fidaxomicin. In patients with available data, the success rate of FMT at 8 and 52 weeks was 82.7% (48/58) and 82.6% (43/52), respectively. Two patients (3.4%) had a repeat FMT for CDI recurrence. No major complications, mortalities related to FMT were reported in our study. Failure of FMT at 8 and 52 weeks was associated with female gender, IBD, and immunosuppressants. In our study, IBD was associated with hypertension, PPI, immunosuppressants, and FMT performed without antibiotic coverage for CDI.
Discussion: FMT is safe and effective for recurrent CDI. In our study, we demonstrated that IBD and immunosuppressants, closely related variables, were associated with FMT failure. Previous studies have shown that IBD is associated with poor outcomes in CDI, and in FMT for CDI. However, it is not clear why FMT failures occurred more frequently in females. Prospective studies with larger sample size are needed.
Citation: Mohamed Abdallah, MD; Abdelmohaymin Abdalla, MD; Noah Wiedel, MD; Brett Baloun, MD; Jorge Gilbert, MD. P0113 - FECAL MICROBIOTA TRANSPLANTATION FOR RECURRENT CLOSTRIDIOIDES DIFFICILE INFECTION: EFFICACY AND PREDICTORS OF SUCCESS. Program No. P0113. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.