FMT safe, well tolerated for recurrent CDI in IBD
Fecal microbiota transplantation for recurrent Clostridioides difficile infection in patients with inflammatory bowel disease was safe and well tolerated and resulted in a high rate of C. difficile decolonization, according to a study published in Gastroenterology.
“Additionally, positioning FMT earlier in the treatment course for patients with IBD-CDI may improve FMT failure rates,” Jessica R. Allegretti, MD, MPH, of the Brigham and Women’s Hospital Crohn’s and Colitis Center, and colleagues wrote.
Researchers performed an open-label prospective, single-arm cohort study at four tertiary care FMT centers comprising 50 patients with a confirmed IBD diagnosis (Crohn’s disease n = 15; ulcerative colitis n = 35) and two or more confirmed CDI episodes within 12 months or most recent episode occurring within 3 months. Investigators collected baseline IBD and CDI data. All patients received a single FMT via colonoscopy. Additionally, four health donors received screening. At 1, 8 and 12 weeks post-FMT, investigators performed stool testing such as glutamate dehydrogenase, toxin enzyme immunoassay and PCR to evaluate CDI and C. difficile colonization rates regardless of symptoms.
FMT failure through week 8, which included diarrhea and stool testing positive for C. difficile via two-step testing using glutamate dehydrogenase and toxin enzyme immunoassay, served as the primary outcome. Patients underwent a second FMT if they met criteria for failure. Other outcomes inlcuded C. difficile colonization among patients without diarrhea whose stool remained positive via PCR post-FMT.
Results showed 49 of the 50 patients underwent treatment. There were five FMT failures, four of which were from diarrhea and one was a positive stool test via glutamate dehydrogenase and toxin enzyme immunoassay. Three patients had three prior episodes of CDI and two patients had two episodes of CDI.
“All [four] underwent a second FMT from the same donor and achieved clinical cure through week 8.” Allegretti and colleague wrote. “Two additional patients received a second FMT based on investigator discretion but did not meet the criteria for FMT failure (toxin enzyme immunoassay and polymerase chain reaction negative, but ongoing symptoms).”
According to researchers, 45 patients experienced C. difficile decolonization 1-week after FMT and remained polymerase chain reaction negative.
“Importantly, we found that the majority of patients were decolonized post-FMT, which may have public health implications in avoiding spreading C. difficile,” Allegretti and colleagues wrote.