Abstract
Background Fecal microbiota transplantation (FMT) is a well-established therapeutic option for patients with antibiotic resistant Clostridioides difficile infection (CDI). However, the efficacy of FMT in patients with chronic liver disease remains elusive. Aims We studied the effect of FMT on chronic liver disease (CLD) patients with CDI at our tertiary medical center. Methods A cohort of all patients who received FMT from December 2012 to May 2014 for refractory or recurrent CDI was identified. Patients were monitored for a year after FMT. Descriptive analysis was conducted to compare the effect of FMT in patients with and without CLD. Results A total of 201 patients with CDI received FMT, 14 of which had a history of CLD. Nine of these patients exhibited cirrhosis of the liver with a mean Child-Turcotte-Pugh score of 8. CDI development in these patients was associated with recent exposure to antibiotics and was observed to be significantly different between both groups (17% of CLD patients vs. 58% in the general cohort, p = 0.01). Four patients with CLD received >1 FMT, of which 2 did not respond to treatment. There was no significant difference between patients with liver disease and the rest of the cohort with regard to FMT response (12/14 (87%) vs. 164/187 (88%), p = 0.01). Four patients with CLD received >1 FMT, of which 2 did not respond to treatment. There was no significant difference between patients with liver disease and the rest of the cohort with regard to FMT response (12/14 (87%) vs. 164/187 (88%), Conclusion FMT is a safe and effective therapy against CDI for patients with CLD and cirrhosis.
Highlights
Antibiotic resistant Clostridioides difficile infection (CDI) is a major public health concern with a high death rate [1,2,3]
The high therapeutic efficacy of Fecal microbiota transplantation (FMT) for recurrent CDI is an important proof of concept that substantial modification of the gut microbiota can be an effective modality for treatment of other diseases in humans such as primary sclerosing cholangitis, inflammatory bowel disease, and serious antibiotic-associated diarrhea [7,8,9,10]
Response to FMT did not differ between both groups based on immunosuppression, route of FMT delivery, number of CDIs within the last 3 months, recent hospitalization, recent surgeries, or Charlson Comorbidity Index (Table 2)
Summary
Antibiotic resistant Clostridioides difficile infection (CDI) is a major public health concern with a high death rate [1,2,3]. Studies on the efficacy of FMT in chronic liver disease (CLD) patients with CDI are limited. Fecal microbiota transplantation (FMT) is a well-established therapeutic option for patients with antibiotic resistant Clostridioides difficile infection (CDI). The efficacy of FMT in patients with chronic liver disease remains elusive. We studied the effect of FMT on chronic liver disease (CLD) patients with CDI at our tertiary medical center. A total of 201 patients with CDI received FMT, 14 of which had a history of CLD. Nine of these patients exhibited cirrhosis of the liver with a mean Child-Turcotte-Pugh score of 8. There was no significant difference between patients with liver disease and the rest of the cohort with regard to FMT response (12/14 (87%) vs 164/187 (88%), p = 0:68). FMT is a safe and effective therapy against CDI for patients with CLD and cirrhosis
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