Background & Aims

Fecal microbiota transplantation (FMT) is recommended for recurrent Clostridioides difficile infection (CDI). FMT cures nearly 80% of patients with severe or fulminant CDI (SFCDI) when utilized in a sequential manner. We compared outcomes of hospitalized patients before and after implementation of an FMT program for SFCDI and investigated whether the changes could be directly attributed to the FMT program.

Methods

We performed a retrospective analysis of characteristics and outcomes of patients hospitalized for SFCDI (430 hospitalizations) at a single center, from January 2009 through December 2016. We performed subgroup analyses of 199 patients with fulminant CDI and 110 patients with refractory SFCDI (no improvement after 5 or more days of maximal anti-CDI antibiotic therapy). We compared CDI-related mortality within 30 days of hospitalization, CDI-related colectomy, length of hospital stay, and readmission to the hospital within 30 days before (2009–2012) vs after (2013–2016) implementation of the inpatient FMT program.

Results

CDI-related mortality and colectomy were lower after implementation of the FMT program. Overall, CDI-related mortality was 10.2% before the FMT program was implemented vs 4.4% after (P = .02). For patients with fulminant CDI, CDI-related mortality was 21.3% before the FMT program was implemented vs 9.1% after (P = .015). For patients with refractory SFCDI, CDI-related mortality was 43.2% before the FMT program vs 12.1% after (P < .001). The FMT program significantly reduced CDI-related colectomy in patients with SFCDI (6.8% before vs 2.7% after; P = .041), in patients with fulminant CDI (15.7% before vs 5.5% after; P = .017), and patients with refractory SFCDI (31.8% vs 7.6%; P = .001). The effect of FMT program implementation on CDI-related mortality remained significant for patients with refractory SFCDI after we accounted for the underlying secular trend (odds ratio, 0.09 for level change; P = .023).

Conclusions

An FMT program significantly decreased CDI-related mortality among patients hospitalized with refractory SFCDI.

中文翻译：

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粪便微生物群移植降低难治性严重或暴发性艰难梭菌感染患者的死亡率。

背景与目标

对于复发性艰难梭菌感染 (CDI)，建议进行粪便微生物群移植 (FMT )。当以连续方式使用时，FMT 可治愈近 80% 的重度或暴发性 CDI (SFCDI) 患者。我们比较了实施 SFCDI 的 FMT 计划之前和之后住院患者的结果，并调查了这些变化是否可以直接归因于 FMT 计划。

方法

我们对 2009 年 1 月至 2016 年 12 月在单个中心因 SFCDI 住院的患者（430 次住院）的特征和结局进行了回顾性分析。我们对 199 名暴发性 CDI 患者和 110 名难治性 SFCDI 患者（治疗后无改善）进行了亚组分析。 5 天或更多天的最大抗 CDI 抗生素治疗）。我们比较了住院 FMT 计划实施前（2009-2012 年）和实施后（2013-2016 年）30 天内住院 30 天内 CDI 相关死亡率、CDI 相关结肠切除术、住院时间和再入院时间。

结果

实施 FMT 计划后，CDI 相关死亡率和结肠切除术降低。总体而言，在 FMT 计划实施之前，CDI 相关死亡率为 10.2%，而实施之后为 4.4% ( P = .02)。对于暴发性 CDI 患者，FMT 计划实施前 CDI 相关死亡率为 21.3%，而实施后为 9.1% ( P = .015)。对于难治性 SFCDI 患者，FMT 计划前 CDI 相关死亡率为 43.2%，而 FMT 计划后为 12.1% ( P < .001)。FMT 计划显着减少了 SFCDI 患者（之前为 6.8% 对之后 2.7%；P = .041）、暴发性 CDI 患者（之前为 15.7% 对之后为 5.5%；P = .017）和患者的CDI 相关结肠切除术使用难治性 SFCDI（31.8% 对 7.6%；P = .001）。在我们考虑了潜在的长期趋势后，FMT 计划实施对 CDI 相关死亡率的影响对于难治性 SFCDI 患者仍然显着（优势比，水平变化为 0.09；P = .023）。

结论

FMT 计划显着降低了难治性 SFCDI 住院患者的 CDI 相关死亡率。