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Long-term Follow-up Study of Fecal Microbiota Transplantation for Severe and/or Complicated Clostridium difficile Infection

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Goal:

Our aim was to investigate fecal microbiota transplantation (FMT) efficacy in patients with severe and/or complicated Clostridium difficile infection (CDI).

Background:

FMT is successful for recurrent CDI, although its benefit in severe or complicated CDI has not specifically been evaluated.

Study Methods:

A multicenter long-term follow-up study was performed in patients who received FMT for severe and/or complicated CDI (diagnosed using standard criteria). Pre-FMT and post-FMT questionnaires were completed. Study outcomes included cure rates and time to resolution of symptoms.

Results:

A total of 17 patients (82% inpatients, 18% outpatients) were included (76.4% women; mean age, 66.4 y; mean follow-up, 11.4 mo). Patients had severe and complicated (76.4%) or either severe or complicated (23.6%) CDI. Sixteen patients (94.1%) had diarrhea, which resolved in 12 (75%; mean time to resolution, 5.7 d) and improved in 4 (25%) after FMT. Eleven patients (64.7%) had abdominal pain, which resolved in 8 (72.7%; mean time to resolution, 9.6 d) and improved in 3 (27.3%) after FMT. Two of 17 patients experienced early CDI recurrence (≤90 d) after FMT (primary cure rate, 88.2%); and in 1 patient, a second FMT resulted in cure (secondary cure rate, 94.1%). Late CDI recurrence (≥90 d) was seen in 1 of 17 patients (5.9%) in association with antibiotics and was successfully treated with a repeat FMT. No adverse effects directly related to FMT occurred.

Conclusions:

FMT was successful and safe in this cohort of patients with severe or complicated CDI. Primary and secondary cure rates were 88.2% and 94.1%, respectively.
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Keywords: Clostridium difficile infection; fecal microbiota transplantation; infectious diarrhea

Document Type: Research Article

Affiliations: 1: Montefiore Medical Center, Bronx, NY 2: Centre for Digestive Diseases, Five Dock, NSW, Australia 3: Brown Alpert Medical School, Providence, RI 4: Integris Baptist Medical Center, Oklahoma City, OK 5: Division of Gastroenterology, University of Washington, Seattle 6: Peace Health Southwest Hospital, Vancouver, WA 7: Mayo Clinic, Rochester, MN 8: East Bay Center for Digestive Health, Oakland, CA 9: Ochsner Medical Center, New Orleans, LA

Publication date: 01 May 2016

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