Antibiotic use 8 weeks after FMT increases risk for treatment failure
Antibiotic exposure within 8 weeks of fecal microbiota transplantation, or FMT, was associated with a nearly threefold increased risk for recurrence of Clostridium difficile infection, according to recent data.
“Early antibiotic exposure among CDI patients who have undergone a recent FMT is not uncommon within 8 weeks of FMT,” Jessica R. Allegretti, MD, MPH, of the Division of Gastroenterology at Brigham and Women’s Hospital, and colleagues wrote in Clinical Infectious Diseases. “Accordingly, we aimed to assess the burden of early antibiotic use among patients who had undergone FMT within the past 8 weeks and its impact on FMT failure.”
Allegretti and colleagues evaluated data on 349 patients (mean age, 62.8 years) who underwent FMT for recurrent CDI between May 2012 and September 2016. The researchers analyzed standardized questionnaires that provided information on participants’ demographics, CDI history, severity of CDI before FMT, antibiotic use and underlying infections and conditions. They also reviewed medical records, clinical notes and pharmacy records to confirm non-CDI antibiotic use.
The participants were assessed for treatment failure during clinic visits and phone calls. Overall, the treatment failure rate was 12.6%. Among the 29 patients (8.3%) who received non-CDI antibiotics within 8 weeks of FMT, eight were confirmed to have CDI, yielding an FMT failure rate of 27.6% in this group. After adjusting for other risk factors, early antibiotic use was the strongest predictor of FMT failure (OR = 2.86; 95% CI, 1.16-7.06).
According to the researchers, most patients (70.5%) received antibiotics within 4 weeks of FMT, mostly for urinary tract infections (36%), pneumonia/upper respiratory tract infections (20%) and cellulitis or skin/soft tissue infections (12%). The most common antibiotics that patients received were ciprofloxacin (30%), cephalexin (20%) and amoxicillin or amoxicillin-clavulanic acid (12%).
“Clinicians should be thoughtful about antibiotic use and optimize antibiotic stewardship practices in the immediate post-FMT period,” Allegretti and colleagues concluded. “Appropriate diagnostics should be utilized and narrow spectrum antibiotics should be utilized when appropriate, preferably in consultation with an FMT/infectious disease specialist.” – by Stephanie Viguers
Disclosure: One author reports receiving institutional grant support from the University of Alberta Hospital Foundation.