Compared with standard of care, fecal microbiota transplantation decreases mortality among patients with severe and fulminant Clostridioides difficile infection, according to study results.
Ari M. Grinspan, MD, of the division of gastroenterology at Icahn School of Medicine at Mount Sinai, and colleagues wrote that few advances have been made in the treatment of severe and fulminant CDI, a condition associated with poor long-term outcomes.
“For cases of recurrent or refractory CDI, fecal microbiota transplant has been shown to be extremely efficacious,” they wrote. “However, the utility of FMT in severe or fulminant CDI, especially for critically ill, hospitalized patients, is not well described in the current literature.”
Researchers conducted a retrospective, match cohort study to compare outcomes of patients with severe or fulminant CDI treated with antibiotics and FMT with patients treated with standard of care (antibiotics alone). The study comprised 48 patients hospitalized with severe or fulminant CDI who needed treatment in the intensive care unit.
Among all 48 patients, 19 patients died during hospital admission for an overall mortality rate of 39.6%. Among patients treated with FMT, three of 19 patients died during hospitalization. In the antibiotic group, 16 of 32 patients died.
Researchers determined that there was a 31.2% absolute risk reduction in mortality for patients who underwent FMT. FMT was also associated with a mortality benefit (adjusted OR = 0.23; 95% CI, 0.05–0.97).
There were no significant differences between groups in secondary outcomes, including colectomy rate, repeat CDI and readmission.
Grinspan and colleagues wrote that their findings add to growing evidence that FMT can be used in patients with severe or fulminant CDI either instead of or alongside surgery.
“Most importantly, we firmly believe that early intervention in this high-risk cohort is key,” they wrote. “Further prospective studies are needed to confirm our findings, assess the overall safety of FMT and ensure that results are applicable to larger cohorts of patients with severe and fulminant CDI.” – by Alex Young
Disclosures: Grinspan reports receiving research fees from Merck and Takeda. Please see the full study for all other authors relevant financial disclosures.