8 Things to Know: FMT for C. Diff Infection Safe in Immunocompromised Patients

The gut microbiome has been heralded as one of the most exciting areas of GI research. Fecal microbiota transplantation is perhaps one of the most promising products of this research.

Clostridium  difficile infections are estimated to generate an annual economic burden of more than $1 billion. An Infectious Disease Special Edition report found FMT to be more cost-effective than metronidazole and fidaxomicin, two first-line antibiotic therapies. The FDA initially required a new drug application for the use of the procedure but has since reversed its decision. Hospitals and even surgery centers have begun offering the procedure. But, little research has been done on whether or not FMT is safe for immunocompromised patients, a group particularly susceptible to C. diff.

A recent study published in the American Journal of Gastroenterology examines the use of FMT in immunocompromised patients with recurrent, refractory or severe CDI. Here are eight things to know about the 80-patient study.

•    Of the participants, 55 percent had recurrent CDI, 11 percent had refractory CDI and 34 percent had severe CDI.
•    The majority of the patients, 79 percent, were outpatients at the time of FMT. Patients were considered immunocompromised due to HIV/AIDS, solid organ transplant, oncologic condition, immunosuppressive therapy for inflammatory bowel disease and other medical conditions.
•    FMT resulted in a cure rate of 78 percent after a single use; 62 percent of patients suffered no recurrence at least 12 weeks post procedure.
•    Twelve patients underwent a second FMT, eight of whom had no recurrent CDI. The overall cure rate of the study group when including results from the second FMT was 89 percent.
•    Twelve patients experienced serious adverse events within 12 weeks of FMT, 10 of which were hospitalizations.
•    Two deaths occurred within 12 weeks of FMT, one due to aspiration during sedation for FMT and the other unrelated to FMT.
•    None of the patients experienced infection definitively related to FMT.
•    The researchers concluded that FMT is effective for CDI in immunocompromised patients, causing few serious adverse events and no related infection.

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