FMT effective for CDI in patients with cirrhosis
Monika Fischer, MD, of the division of gastroenterology at Indiana University School of Medicine, and colleagues wrote that patients with cirrhosis are at higher risk for CDI due to dysbiosis, functional immunosuppression and frequent use of antibiotic therapies. However, the FMT working group has recommended against FMT for this population due to the potential for adverse events.
“Hospitalized patients with cirrhosis have double the incidence of CDI and higher rates of CDI-related complications including mortality and length of stay compared to patients without cirrhosis,” they wrote. “Even in large studies of FMT for CDI, patients with cirrhosis comprise only a small fraction of the study population, limiting the ability to delineate outcomes based on liver disease severity or complications, and liver disease-specific medications.”
Researchers conducted a retrospective study comprising 63 adults with cirrhosis who underwent FMT for CDI. Patients had a median model for end-stage liver disease score of 14.5, and 24 patients had decompensated cirrhosis.
Investigators collected data on patient demographic and characteristics of cirrhosis, CDI, and FMT from medical records to compare differences among patients with different severity of cirrhosis and FMT success vs. failure at 8 weeks of follow up.
Fifty-four patients achieved success with FMT.
Among patients who failed FMT, a higher proportion used non-CDI antibiotics at the time of FMT (44.4% vs. 5.6%; P < .001), had Child-Pugh score of B or C (100% vs. 37.7%; P < .001), used probiotics (77.8% vs. 24.1%; P = .003), had pseudomembranes (22.2% vs. 0; P = .18), and underwent FMT in an inpatient setting (45.5% vs. 19%; P = .039), compared with patients who had success with FMT.
Fischer and colleagues also found that use of non-CDI antibiotics at the time of FMT (OR = 17.43; 95% CI, 2–152.03) and use of probiotics (OR = 11.9; 95% CI, 1.81–78.3) were associated with greater risk for FMT failure.
Twenty-one patients experienced FMT-related adverse events (33.3%), most of which were self-limited abdominal cramps or diarrhea. Investigators reported five serious adverse events, but none involved infection or death.
“Single FMT appears effective in the treatment of CDI in patients with cirrhosis,” Fischer and colleagues wrote. “On multivariable analysis, non-CDI antibiotic and probiotic use at time of FMT was associated with FMT failure. Adverse event rates due to FMT in this series were low.”