Abstract
Purpose: Patients with RCDI often fail multiple courses of standard Rx, with recurrence rates of up to 50%. FMT has been reported efficacious in single center case series, but here we report a collected experience from 5 geographically disparate centers in the U.S. (RI, NY, OK, CA, WA). Methods: We were able to contact 77 of 94 (82%) pts who had a colonoscopic FMT for RCDI ≥3 mos previously. Pts completed a 36 item questionnaire via mail or phone contact. Rx failure was defined as continued CDI or recurrence within 3 mos of FMT. Results: Pt population: 56 F, 21 M; mean age 65 (22-87) yrs. 31 pts were hospitalized, homebound or in a SNF at the time of FMT. Mean duration of illness: 11 mos. # Rx courses pre-FMT 5 (2-15 including metronidazole (61), vancomycin often with pulse/taper courses (76), rifaximin (17), and probiotics (59). Sxs: diarrhea ≥6/day (52); wt loss of 5-60 lbs (mean: 20 lbs; [61 pts]); severe fatigue (41). Donors: spouse/partner, 46; 1st degree relative, 19; friend, 9; other relative, 2; unknown to pt, 1; resided in same household (56). 4 pts received a 2nd FMT. Mean follow up time post FMT: 17 mos (3-68). Mean time to resolution and improvement in diarrhea and fatigue: 6 days (≤3 days in 57) and 4 wks (≤1 week in 51) respectively. There were 7 Rx failures (9%) of which 4 had a successful subsequent 2 wk Rx course (vanco; vanco + Florastor; vanco + Alinia; vanco + Kefir); unsuccessful vanco with successful 2nd FMT 2; 1 death (hospice care). 30 of the successfully Rxd pts had stool toxin assay during f/u: all 30 negative. During long-term follow-up, 30 pts received antibiotics for other infections and CDI recurred in 8 of these pts (27%) but in no others. 2 had a successful 2nd FMT. When asked about their choice of Rx if CDI recurred, 53% would have FMT as their preferred 1st Rx. 7 deaths occurred during f/u: only 1 possibly related to CDI. Two pts had improvement in a medical condition existing pre-FMT: arthritis (1), sinus allergies (1). 4 pts developed a new medical condition of potential interest during follow-up; peripheral neuropathy in a non-diabetic; Sjogren's; ITP; rheumatoid arthritis. Conclusion: 1. FMT had a success rate of 91% of RCDI in pts who were, on average, elderly, debilitated and had undergone multiple failed Rx courses, including alternative antibiotics, pulse and tapered Vanco, and probiotics. 2. Despite a mean length of illness of 11 mos, response to FMT was rapid (mean: 6 days). 3. Response to FMT was sustained; no pt developed RCDI without subsequent antibiotic Rx, during mean f/u of 17 mos. 3. There was a strong female predominance in RCDI. 4. FMT is a viable treatment option for pts who have ≥2 prior bouts of CDI.
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