Fecal microbiota transplant in immunocompromised patients: Encouraging results in a vulnarable population
| Autor: | Elizabeth L. Hohmann, Lawrence J. Brandt, Olga C. Aroniadis, Michael Gluck, John Y. Kao, Thomas J. Borody, Kevin Rank, Andrea Giovanelli, Neil Stollman, Ilan Youngster, Dina Kao, Christina M. Surawicz, Stephen M. Vindigni, Anita Afzali, Colleen R. Kelly, Shelley Gordon, Mark Mellow, Monika Fischer, Arnab Ray, Alexander Khoruts, Margot Schwartz, Namita Singh, Chioma Ihunnah, Daniel P. McQuillen, Amy Barto, Krishna Rao, David L. Suskind |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2014 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent Population Treatment outcome digestive system Faecal microbiota transplantation Article Microbiology Feces Immunocompromised Host fluids and secretions Internal medicine Surveys and Questionnaires medicine Humans education Intensive care medicine Child Enterocolitis Pseudomembranous Aged Retrospective Studies Aged 80 and over education.field_of_study Hepatology business.industry Clostridioides difficile Microbiota Gastroenterology Retrospective cohort study Fecal bacteriotherapy Clostridium difficile Middle Aged stomatognathic diseases surgical procedures operative Treatment Outcome Female business |
| Popis: | 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.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.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 UC100 days after FMT.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. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|