Abstract
BackgroundFaecal microbial transplantation (FMT) is currently the most effective treatment of recurrent Clostridioides difficile infection (CDI). However, up to 20% of patients experience further recurrences after single FMT. The mechanisms that lead to FMT failure and its risk factors are poorly understood. Comorbidity is one of the risk factors of the failure of standard antibiotic therapy of recurrent CDI. It is not known if comorbidity is also associated with the risk of FMT failure.MethodsWe conducted a prospective observational cohort study in order to elucidate if comorbid status is associated with FMT failure. Patients with microbiologically proven recurrent CDI were recruited and underwent FMT via retention enema. Patients were followed up for 12 weeks after FMT for signs and symptoms of CDI recurrence. Single FMT failure was defined as recurrence of diarrhoea and a positive stool test for the presence of C. difficile antigen or toxin at any time point during the 12 weeks of follow-up. We assessed the association of single FMT failure with possible manageable and unmanageable risk factors. As a surrogate of comorbid status, we used Charlson Comorbidity Index (CCI) ≥ 7.ResultsA total of 60 patients that underwent single FMT (34 women, 26 men) were included in the study. Overall, 15 patients (25%) experienced single FMT failure. 24 patients (40%) had CCI ≥ 7, and 45.0% patients with CCI ≥ 7 experienced failure of single FMT. Patients who experienced single FMT failure had a significantly higher CCI and significantly lower albumin concentration as compared to patients who experienced single FMT success. There was no difference in age, C-reactive protein concentration, leukocyte count and time from FMT to first defecation. In multivariate analysis, CCI ≥ 7 was positively associated with the failure of single FMT. Analysis was controlled for sex, age, time from FMT to first defecation, concomitant PPI therapy, severe CDI, hospital-acquired infection and albumin concentration.ConclusionsComorbid status surrogated by CCI is positively associated with the failure of single FMT in the treatment of recurrent CDI.
Highlights
Faecal microbial transplantation (FMT) is currently the most effective treatment of recurrent Clostridioides difficile infection (CDI)
We found an association of FMT failure with Charlson Comorbidity Index (CCI) ≥ 5, CCI ≥ 7, CCI ≥ 9 and male sex
We find no association with concomitant Proton pump inhibitor (PPI) therapy, severe CDI, hospital-acquired CDI, history of ≥3 recurrences and CCI ≥ 3 (Table 3)
Summary
Faecal microbial transplantation (FMT) is currently the most effective treatment of recurrent Clostridioides difficile infection (CDI). The mechanisms that lead to FMT failure and its risk factors are poorly understood. Comorbidity is one of the risk factors of the failure of standard antibiotic therapy of recurrent CDI. Clostridioides difficile, formerly known as Closridium difficle is an anaerobic, spore-forming, Gram-positive bacillus It may be part of normal intestinal flora in neonates but can lead to severe health care-associated colitis. Since severe underlying diseases are predictors of recurrent CDI, we suppose that it may contribute to the risk of FMT failure. To objectively assess comorbid status, we used the Charlson Comorbidity Index (CCI) as a well-established surrogate marker of comorbidity It was developed and validated as a measure of 1-year mortality risk and a marker of disease burden.
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