Treatment of Recurrent Clostridium difficile Infection With Fecal Microbiota Transplantation in a Community Ambulatory Surgical Center

Abstract

Introduction: Clostridium difficile infection (CDI) continues to have a large societal burden with increasing relapse and refractory infections. Meta-analyses have shown that fecal microbiota transplant (FMT) is effective against recurrent CDI. However, these studies have primarily been limited to the academic setting. This study compared the published success rates to a community-based program at an ambulatory surgical center (ASC). Methods: An IRB approved retrospective study was conducted on patients from an outpatient community program who completed FMT between 1 April 2014 and 31 December 2016 at an ASC. Inclusion criteria: at least 3 episodes of recurrent CDI, previous treatments with first line therapies for CDI, refractory CDI, failing vancomycin therapy after greater than one week, able to safely undergo and consent to colonoscopy, able to identify potential donor, ability to stop gastric acid suppression medications and concomitant antibiotics. Exclusion criteria: severe bowel disease precluding colonoscopy, severe underlying immune suppression, decompensated liver cirrhosis. Donor stool was diluted in normal saline and instilled through the biopsy channel of a colonoscope to the right colon. The primary outcome measured was documented resolution of CDI without recurrence within 60 days of FMT. Results: 37 patients were evaluated, mean age 69 (range 32-94), 76% female. Patients underwent an average of 3.6 rounds of antibiotics prior to FMT (range 3-8). 37 FMTs were completed initially with resolution rate of 36/37 (97.3%) after 60 days of follow up. Four patients had recurrent CDI, one within 2 months, and three patients 14.3 months (range 7-27) after FMT. 2/4 patients underwent a second FMT, with recurrent CDI in 1/2 patients. Overall, after a maximum of two FMTs, the recurrence rate of CDI was 3/37 (8.1%). Patients who had responded to FMT were negative for documented CDI after an average of 21.6 months of follow up (range 2-48). There were no reported adverse effects, complications or deaths. Conclusion: The results demonstrated a similar success rate of FMT completed in a community-based program compared with the current published data (81-94%) in the academic setting. In addition, the low recurrence rate suggests a durable response to FMT. The high success rate and low recurrence rate, along with no reported complications, should result in more community-based programs implementing FMT in ASCs leading to increased patient access.