All-Cause Hospital Admissions Decreased After Fecal Microbiota Transplantation for Recurrent Clostridium difficile Infection

Abstract

Introduction:Clostridium difficileinfection (CDI) is currently the most frequent health-care acquired infection. It is associated with debilitating diarrhea, sepsis, shock, renal failure, and intestinal perforation and has an initial recurrence rate of 20% rising to 65% with subsequent recurrences. Costs in the US are estimated at 4.8 billion annually. Fecal Microbiota Transplantation (FMT) is used to correct the dysbiosis associated with recurrent CDI (rCDI) and prevent future recurrence. We hypothesized a decrease in hospital admissions after successful FMT for rCDI. Methods: A retrospective chart review was conducted of all recipients of FMT for rCDI at our institution from September 2013 to April 2016 to compare the frequency of CDI-associated hospital admissions in the six months before FMT to frequency six months after FMT. A similar comparison was done for all-cause admissions except CDI. One patient was excluded from analysis due to incomplete preparation for FMT. Results: 105 patients with rCDI underwent FMT with a median age of 69 and 74.7% were female. There were 130 hospitalizations for CDI documented in the six months prior to FMT. In the six months post FMT there were 11 admissions for CDI (mean 1.25 compared to 0.10). The cohort was admitted an additional 34 times in the six months prior to FMT for causes other than CDI which included diabetic ketoacidosis, sepsis, hypokalemia, dementia, hypertension, fall with subdural hematoma, altered mental status, alcohol withdrawal, and alcoholic ketoacidosis. In the six months after FMT there 27 admissions for causes other than CDI including feeding tube malfunction, sepsis, pneumonia, diabetes, altered mental status, urosepsis, urinary tract infection, dehydration, fall, subdural hematoma, epilepsy, lactic acidosis, cocaine abuse, and gastroparesis. The mean hospitalization rate decreased from 0.33 to 0.26. Conclusion: This retrospective study suggests that the number of hospital admissions for CDI may be dramatically reduced by FMT for rCDI in the six months post FMT. Our results also revealed a decreased number of admissions post FMT for other comorbidities, thus suggesting that FMT improves the overall health the overall health of patients with rCDI. Our results call for a multicenter study of 30-day and 6-month hospital admission rates pre- and post-FMT for rCDI as there may be a role for early intervention with FMT to decrease the deleterious effect of rCDI on all-cause illnesses.