Background & Aims

Clostridioides difficile infection (CDI) harms a large proportion of patients with cirrhosis. Fecal microbiota transplantation (FMT) is recommended for recurrent CDI, but its effects in patients with cirrhosis have not been established. We performed a multicenter observational study to evaluate the efficacy and safety of FMT for CDI in patients with cirrhosis.

Methods

We performed a retrospective study of 63 adults with cirrhosis (median model for end-stage liver disease score, 14.5; 24 patients with decompensated cirrhosis) who underwent FMT for CDI from January 2012 through November 2018 at 8 academic centers in the United States, Canada, and Italy. We collected data on patient demographics and characteristics of cirrhosis, CDI, and FMT from medical records and compared differences among patients with different severities of cirrhosis, and FMT successes vs failures at the 8-week follow-up evaluation. We also obtained data on adverse events (AEs) and severe AEs within 12 weeks of FMT.

Results

Patients underwent FMT for recurrent CDI (55 of 63; 87.3%), severe CDI (6 of 63; 9.5%), or fulminant CDI (2 of 63; 3.2%) primarily via colonoscopy (59 of 63; 93.7%) as outpatients (47 of 63; 76.8%). FMT success was achieved for 54 patients (85.7%). Among FMT failures, a higher proportion used non-CDI antibiotics at the time of FMT (44.4% vs 5.6%; P < .001), had Child–Pugh scores 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 = .018), and underwent FMT as inpatients (45.5% vs 19%; P = .039), compared with FMT successes. In multivariable analysis, use of non-CDI antibiotics at the time of FMT (odds ratio, 17.43; 95% CI, 2.00–152.03; P = .01) and use of probiotics (odds ratio, 11.9; 95% CI, 1.81–78.3; P = .01) were associated with a greater risk of FMT failure. FMT-related AEs occurred in 33.3% of patients (21 of 63)—most were self-limited abdominal cramps or diarrhea. There were only 5 severe AEs that possibly were related to FMT; none involved infection or death.

Conclusions

In a retrospective study, we found FMT to be safe and effective for the treatment of CDI in patients with cirrhosis.

中文翻译：

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粪便微生物群移植对艰难梭菌感染和肝硬化患者安全有效

背景与目标

艰难梭菌感染 (CDI) 危害很大一部分肝硬化患者。粪便微生物群移植 (FMT) 被推荐用于复发性 CDI，但其对肝硬化患者的影响尚未确定。我们进行了一项多中心观察性研究，以评估 FMT 治疗肝硬化患者 CDI 的疗效和安全性。

方法

我们对 2012 年 1 月至 2018 年 11 月在美国和加拿大的 8 个学术中心接受 FMT 治疗 CDI 的 63 名肝硬化成人（终末期肝病评分中位数模型为 14.5；24 名失代偿期肝硬化患者）进行了一项回顾性研究，和意大利。我们从病历中收集了有关肝硬化、CDI 和 FMT 的患者人口统计学和特征的数据，并在 8 周的随访评估中比较了不同严重程度的肝硬化患者之间的差异，以及 FMT 成功与失败。我们还在 FMT 后 12 周内获得了有关不良事件 (AE) 和严重 AE 的数据。

结果

患者接受 FMT 治疗复发性 CDI（63 名中的 55 名；87.3%）、重度 CDI（63 名中的 6 名；9.5%）或暴发性 CDI（63 名中的 2 名；3.2%），主要通过结肠镜检查（63 名中的 59 名；93.7%）作为门诊患者（63 个中的 47 个；76.8%）。54 名患者 (85.7%) 取得了 FMT 成功。在 FMT 失败中，更高比例在 FMT 时使用非 CDI 抗生素（44.4% 对 5.6%；P < .001），Child-Pugh 评分为 B 或 C（100% 对 37.7%；P < .001 )、使用益生菌 (77.8% vs 24.1%; P  = .003)、有假膜 (22.2% vs 0; P  = .018)，并在住院患者中接受 FMT (45.5% vs 19%; P  = .039)，比较FMT 成功。在多变量分析中，FMT 时使用非 CDI 抗生素（优势比，17.43；95% CI，2.00–152.03；P  = .01）和益生菌的使用（优势比，11.9；95% CI，1.81–78.3；P  = .01）与 FMT 失败的更大风险相关。33.3% 的患者（63 名中的 21 名）发生 FMT 相关的 AE——大多数是自限性腹部绞痛或腹泻。只有 5 个可能与 FMT 相关的严重 AE；没有人涉及感染或死亡。

结论

在一项回顾性研究中，我们发现 FMT 治疗肝硬化患者的 CDI 是安全有效的。