Fecal microbiota transplantation may reduce the mortality of patients with severe and fulminant Clostridioides difficile infection compared to standard‐of‐care antibiotics in a community hospital. Issue 8 (31st October 2022)

• Record Type: Journal Article
• Authors: Mironova, Maria; Ehrlich, Adam C.; Grinspan, Ari; Protano, Marion‐Anna
• Is Part Of: Journal of digestive diseases. Volume 23:Issue 8/9(2022)
• Page Start: 500
• Page End: 505
• Publication Date: 2022-10-31
• Subjects: Clostridioides difficile infection -- fecal microbiota transplantation -- propensity score -- pseudomembranous enterocolitis -- toxic megacolon; Digestive organs -- Diseases -- Periodicals; Gastroenterology -- Periodicals; 616.3
• DOI: 10.1111/1751-2980.13134
• Languages: English
• ISSNs: 1751-2972

Abstract

Abstract : Objectives: Clostridioides difficile infection (CDI) is known for significant morbidity and mortality. Fecal microbiota transplantation (FMT) is an effective therapy for recurrent and resistant CDI. However, its impact on the mortality rate of patients with severe and fulminant CDI has not been rigorously studied yet. We aimed to evaluate the effectiveness of FMT on the mortality rate of patients with severe or fulminant CDI in a community hospital system. Methods: Our study included 106 inpatients with severe or fulminant CDI. Both standard‐of‐care (SOC) and FMT were provided to 14 (13.2%) patients (the FMT group). SOC antibiotics alone were provided to 92 (86.8%) patients, out of whom 28 patients were included via propensity score matching in a 2:1 ratio (the SOC group). The primary outcome was defined as the composite end‐point of mortality during admission, within 30 and 90 days after discharge, and discharge with comfort measures only. Each component was a secondary end‐point. Results: The primary outcome rate in the FMT group was 7.1% (1/14) compared to 25.0% (7/28) in the SOC group. Univariate analysis demonstrated that FMT decreases mortality (odds ratio [OR] 0.08, 95% confidence interval [CI] 0.01–0.58, P = 0.01). However, multivariate regression did not show statistical significance (OR 0.15, 95% CI 0.01–2.53, P = 0.19), possibly due to the small sample size. Conclusions: FMT may decrease the mortality of patients with severe and fulminant CDI. Large studies are needed to validate these findings. Abstract : We conducted a retrospective case–control study to evaluate the effectiveness of fecal microbiota transplantation (FMT) on the mortality rate of patients with severe or fulminant Clostridioides difficile infection. The control group was treated with standard‐of‐care (SOC) antibiotics and was selected via propensity score matching. The univariate analysis demonstrated that FMT decreases the likelihood of death compared to SOC treatment.