Division of Gastroenterology, Brigham and Women's Hospital, 850 Boylston Street, Suite 201, Chestnut Hill, MA, 02467, USA.
Department of Medicine, Indiana University, Indianapolis, IN, USA.
Dig Dis Sci. 2021 Jan;66(1):213-217. doi: 10.1007/s10620-020-06198-2. Epub 2020 Mar 13.
Fecal microbiota transplantation (FMT) is a highly effective therapy for recurrent Clostridioides difficile infection (CDI); however, a small percentage of patients fail to achieve cure even after two FMTs. This high-risk cohort remains poorly understood.
We performed a multicenter, multinational retrospective review of patients that underwent at least one FMT for a CDI indication at four academic FMT referrals. Patients' data including CDI, FMT, and FMT variables were assessed. The primary outcome was FMT failure after a second FMT defined as persistent diarrhea and positive laboratory test for C. difficile (PCR or toxin) despite a second FMT within 8 weeks of the first FMT. A multivariable logistic regression model was performed to determine predictors of second FMT failure.
A total of 540 patients received at least one FMT during the study period, of which 432 patients had success following the first FMT, 108 had documented failure (25%). Among those who failed the first FMT, 63 patients received a second FMT, of which 36 achieved cure, and 24 had documented failure after the second FMT. Patients that failed the first FMT but did not receive a second FMT and those lost to follow-up were excluded leaving 492 patients included in the analysis. The second FMT failure rate was 4.8% (24/492). Risk factors for second FMT failure identified by multivariable logistic regression included: inpatient status (OR 7.01, 95% CI: 2.37-20.78), the presence of pseudomembranes (OR 3.53, 95% CI: 1.1-11.33), and immunocompromised state (OR 3.56, 95% CI: 1.45-8.72) at the time of first FMT.
This study identifies clinically relevant risk factors predictive of failing a second FMT. Clinicians can use these variables to help identify high-risk patients and provide a better-informed consent regarding the possibility of needing multiple FMTs.
粪便微生物群移植（FMT）是治疗复发性艰难梭菌感染（CDI）的一种非常有效的疗法；然而，即使进行了两次 FMT，仍有一小部分患者无法治愈。这个高风险的患者群体仍然了解甚少。
我们对四家学术性 FMT 转诊中心接受至少一次 FMT 治疗 CDI 指征的患者进行了多中心、多国回顾性研究。评估了患者的 CDI、FMT 和 FMT 变量的数据。主要结局是第二次 FMT 后 FMT 失败，定义为在第一次 FMT 后 8 周内尽管进行了第二次 FMT，但仍持续腹泻和 C. difficile 实验室检测阳性（PCR 或毒素）。进行了多变量逻辑回归模型以确定第二次 FMT 失败的预测因素。
在研究期间，共有 540 名患者接受了至少一次 FMT，其中 432 名患者在第一次 FMT 后成功，108 名患者记录为失败（25%）。在第一次 FMT 失败的患者中，有 63 名患者接受了第二次 FMT，其中 36 名患者治愈，24 名患者在第二次 FMT 后记录为失败。未接受第二次 FMT 且失访的第一次 FMT 失败患者被排除在外，其余 492 名患者纳入分析。第二次 FMT 失败率为 4.8%（24/492）。多变量逻辑回归确定的第二次 FMT 失败的危险因素包括：住院状态（OR 7.01，95%CI：2.37-20.78）、假膜存在（OR 3.53，95%CI：1.1-11.33）和免疫功能低下状态（OR 3.56，95%CI：1.45-8.72）。
本研究确定了可预测第二次 FMT 失败的临床相关危险因素。临床医生可以使用这些变量来帮助识别高风险患者，并就需要多次 FMT 的可能性提供更知情的同意。
