178 Short and Long-Term Outcomes of Patients With Severe Complicated Clostridioides (Clostridium) difficile Infection Treated With Fecal Microbiota Transplant

Abstract

INTRODUCTION: Severe complicated Clostridioides difficile infection (SC-CDI) has mortality rates of 20–80%. Standard treatment for SC-CDI refractory to antibiotic therapy includes colectomy with end ileostomy and more recently diverting loop ileostomy, which have mortality rates of 19–57%. Fecal microbiota transplantation (FMT) is a well-established treatment for recurrent CDI, but its use for SC-CDI has not been well-studied. Here, we present short-term and long-term outcomes of patients who underwent FMT for SC-CDI. METHODS: An IRB-approved retrospective cohort study was conducted on patients with SC-CDI who received FMT at a single academic center between 2015–2018. SC-CDI was defined by the 2013 American College of Gastroenterology guidelines. Two patients who underwent both surgery and FMT were excluded. We obtained: WBC count, heart rate (HR), pressor requirement pre-FMT then 24, 48, and 72 hours (h) after FMT, mortality, cause of death, re-admission rate, and re-admission diagnoses. RESULTS: Total 8 patients were identified. Regarding short-term outcomes of FMT, we observed that patients showed clinical improvement within 72 h of FMT. We found that WBC count was significantly decreased at 72 h compared to pre-FMT (9.6 vs 12.9, P = 0.025). Heart rate (HR) was also significantly decreased at 72 h post-FMT (91.6 vs 79.6, P = 0.022). One patient was on vasopressor pre-FMT (norepinephrine 16 mcg/min), and it was discontinued by 72 h post-FMT. Regarding long-term outcomes, 1 patient died 564 days after FMT due to chronic leg infection. All other patients were alive at the time of chart review. All patients had survived at least 1-year post-FMT, 6 for 2-years post-FMT, 5 for 3-years post-FMT, and 3 for 4-year post-FMT. No patient had post-procedural complication from FMT. Average number of FMTs that patients received was 3. Within 1 year of FMT, 3 patients had recurrent admission due to CDI. There were no admissions for CDI beyond 1-year post-FMT. CONCLUSION: Our study showed that patients with SC-CDI had significant clinical improvement within 72 h of FMT. Their long-term survival up to 4 years after FMT was unexpectedly high. FMT is a promising modality for treatment of SC-CDI. Prospective studies are needed to identify the appropriate clinical setting for this promising treatment in patients with SC-CDI (e.g., adjuvant or neoadjuvant to surgery, replacement of surgery, or patients without acute abdomen but refractory to antibiotic therapy).