PMID- 24890442 OWN - NLM STAT- MEDLINE DCOM- 20140909 LR - 20220408 IS - 1572-0241 (Electronic) IS - 0002-9270 (Print) IS - 0002-9270 (Linking) VI - 109 IP - 7 DP - 2014 Jul TI - Fecal microbiota transplant for treatment of Clostridium difficile infection in immunocompromised patients. PG - 1065-71 LID - 10.1038/ajg.2014.133 [doi] AB - OBJECTIVES: Patients who are immunocompromised (IC) are at increased risk of Clostridium difficile infection (CDI), which has increased to epidemic proportions over the past decade. Fecal microbiota transplantation (FMT) appears effective for the treatment of CDI, although there is concern that IC patients may be at increased risk of having adverse events (AEs) related to FMT. This study describes the multicenter experience of FMT in IC patients. METHODS: A multicenter retrospective series was performed on the use of FMT in IC patients with CDI that was recurrent, refractory, or severe. We aimed to describe rates of CDI cure after FMT as well as AEs experienced by IC patients after FMT. A 32-item questionnaire soliciting demographic and pre- and post-FMT data was completed for 99 patients at 16 centers, of whom 80 were eligible for inclusion. Outcomes included (i) rates of CDI cure after FMT, (ii) serious adverse events (SAEs) such as death or hospitalization within 12 weeks of FMT, (iii) infection within 12 weeks of FMT, and (iv) AEs (related and unrelated) to FMT. RESULTS: Cases included adult (75) and pediatric (5) patients treated with FMT for recurrent (55%), refractory (11%), and severe and/or overlap of recurrent/refractory and severe CDI (34%). In all, 79% were outpatients at the time of FMT. The mean follow-up period between FMT and data collection was 11 months (range 3-46 months). Reasons for IC included: HIV/AIDS (3), solid organ transplant (19), oncologic condition (7), immunosuppressive therapy for inflammatory bowel disease (IBD; 36), and other medical conditions/medications (15). The CDI cure rate after a single FMT was 78%, with 62 patients suffering no recurrence at least 12 weeks post FMT. Twelve patients underwent repeat FMT, of whom eight had no further CDI. Thus, the overall cure rate was 89%. Twelve (15%) had any SAE within 12 weeks post FMT, of which 10 were hospitalizations. Two deaths occurred within 12 weeks of FMT, one of which was the result of aspiration during sedation for FMT administered via colonoscopy; the other was unrelated to FMT. None suffered infections definitely related to FMT, but two patients developed unrelated infections and five had self-limited diarrheal illness in which no causal organism was identified. One patient had a superficial mucosal tear caused by the colonoscopy performed for the FMT, and three patients reported mild, self-limited abdominal discomfort post FMT. Five (14% of IBD patients) experienced disease flare post FMT. Three ulcerative colitis (UC) patients underwent colectomy related to course of UC >100 days after FMT. CONCLUSIONS: This series demonstrates the effective use of FMT for CDI in IC patients with few SAEs or related AEs. Importantly, there were no related infectious complications in these high-risk patients. FAU - Kelly, Colleen R AU - Kelly CR AD - Division of Gastroenterology, Brown Alpert Medical School, Women's Medicine Collaborative, Alpert Medical School of Brown University, Providence, Rhode Island, USA. FAU - Ihunnah, Chioma AU - Ihunnah C AD - Division of Gastroenterology, Brown Alpert Medical School, Women's Medicine Collaborative, Alpert Medical School of Brown University, Providence, Rhode Island, USA. FAU - Fischer, Monika AU - Fischer M AD - Indiana University School of Medicine, Indianapolis, Indiana, USA. FAU - Khoruts, Alexander AU - Khoruts A AD - University of Minnesota Medical School, Minneapolis, Minnesota, USA. FAU - Surawicz, Christina AU - Surawicz C AD - University of Washington School of Medicine, Seattle, Washington, USA. FAU - Afzali, Anita AU - Afzali A AD - University of Washington School of Medicine, Seattle, Washington, USA. FAU - Aroniadis, Olga AU - Aroniadis O AD - Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA. FAU - Barto, Amy AU - Barto A AD - Lahey Clinic Hospital and Medical Center, Tufts University School of Medicine, Burlington, Massachusetts, USA. FAU - Borody, Thomas AU - Borody T AD - Centre for Digestive Diseases, Five Dock, Sydney, New South Wales, Australia. FAU - Giovanelli, Andrea AU - Giovanelli A AD - Northern California Gastroenterology Consultants, Inc., Oakland, California, USA. FAU - Gordon, Shelley AU - Gordon S AD - California Pacific Medical Center, San Francisco, California, USA. FAU - Gluck, Michael AU - Gluck M AD - Virginia Mason Medical Center, Seattle, Washington, USA. FAU - Hohmann, Elizabeth L AU - Hohmann EL AD - Massachusetts General Hospital and Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA. FAU - Kao, Dina AU - Kao D AD - University of Alberta, Edmonton, Alberta, Canada. FAU - Kao, John Y AU - Kao JY AD - University of Michigan, Ann Arbor, Michigan, USA. FAU - McQuillen, Daniel P AU - McQuillen DP AD - Lahey Clinic Hospital and Medical Center, Tufts University School of Medicine, Burlington, Massachusetts, USA. FAU - Mellow, Mark AU - Mellow M AD - Integris Baptist Medical Center, Oklahoma, Oklahoma, USA. FAU - Rank, Kevin M AU - Rank KM AD - University of Minnesota Medical School, Minneapolis, Minnesota, USA. FAU - Rao, Krishna AU - Rao K AD - University of Michigan, Ann Arbor, Michigan, USA. FAU - Ray, Arnab AU - Ray A AD - Ochsner Clinic Foundation, New Orleans, Louisiana, USA. FAU - Schwartz, Margot A AU - Schwartz MA AD - Virginia Mason Medical Center, Seattle, Washington, USA. FAU - Singh, Namita AU - Singh N AD - Seattle Children's Hospital, Seattle, Washington, USA. FAU - Stollman, Neil AU - Stollman N AD - Northern California Gastroenterology Consultants, Inc., Oakland, California, USA. FAU - Suskind, David L AU - Suskind DL AD - Seattle Children's Hospital, Seattle, Washington, USA. FAU - Vindigni, Stephen M AU - Vindigni SM AD - University of Washington School of Medicine, Seattle, Washington, USA. FAU - Youngster, Ilan AU - Youngster I AD - Massachusetts General Hospital and Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA. FAU - Brandt, Lawrence AU - Brandt L AD - Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA. LA - eng GR - R21 AI091907/AI/NIAID NIH HHS/United States GR - R21 DK093839/DK/NIDDK NIH HHS/United States GR - R21AI091907/AI/NIAID NIH HHS/United States GR - 1R21DK093839-01A1/DK/NIDDK NIH HHS/United States PT - Journal Article PT - Multicenter Study PT - Research Support, N.I.H., Extramural DEP - 20140603 PL - United States TA - Am J Gastroenterol JT - The American journal of gastroenterology JID - 0421030 SB - IM CIN - Turk J Gastroenterol. 2014 Jun;25(3):346. PMID: 25141333 MH - Adolescent MH - Adult MH - Aged MH - Aged, 80 and over MH - Child MH - *Clostridioides difficile MH - Enterocolitis, Pseudomembranous/*microbiology/*therapy MH - Feces/*microbiology MH - Female MH - Humans MH - *Immunocompromised Host MH - Male MH - *Microbiota MH - Middle Aged MH - Retrospective Studies MH - Surveys and Questionnaires MH - Treatment Outcome PMC - PMC5537742 MID - NIHMS882290 COIS- Potential competing interests: Kelly C.R.: US endoscopy, Inc., Consultant; Seres health, Site PI for clinical trial. Khoruts A.: CIPAC, Ltd, Research Support. Brandt L.: Optimer Pharmaceuticals, Inc, Speaker's Bureau and Research support. Borody, T.: has patents filed in the field of FMT. Stollman N.: Speaker's Bureaus: Optimer Pharmaceuticals, Inc.; Aptalis Pharma; and Otsuka America, Inc; on the advisory board for Doximity; and on the American College of Gastroenterology board of governors. Gordon S.: Cubist, Pharmaceuticals, Inc., Speaker's Bureau. Mellow M.: Optimer Pharmaceuticals, Inc., Speaker's Bureau. EDAT- 2014/06/04 06:00 MHDA- 2014/09/10 06:00 PMCR- 2017/08/01 CRDT- 2014/06/04 06:00 PHST- 2014/01/06 00:00 [received] PHST- 2014/04/21 00:00 [accepted] PHST- 2014/06/04 06:00 [entrez] PHST- 2014/06/04 06:00 [pubmed] PHST- 2014/09/10 06:00 [medline] PHST- 2017/08/01 00:00 [pmc-release] AID - ajg2014133 [pii] AID - 10.1038/ajg.2014.133 [doi] PST - ppublish SO - Am J Gastroenterol. 2014 Jul;109(7):1065-71. doi: 10.1038/ajg.2014.133. Epub 2014 Jun 3.