Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.
Department of Medicine, Rochester General Hospital, Rochester, NY.
J Clin Gastroenterol. 2021 Jul 1;55(6):542-547. doi: 10.1097/MCG.0000000000001398.
Clostridioides difficile infection (CDI) recurs in 10% to 15% after fecal microbiota transplantation (FMT). We identify predictors, and describe management and outcome of patients with recurrent CDI after FMT in a predominantly outpatient cohort.
A nested case-control study of patients undergoing FMT for recurrent CDI from August 2012 to January 2017 was performed. FMT failure was defined as recurrent diarrhea with positive C. difficile stool test during follow-up (≥2 mo). Controls (patients without FMT failures) were matched to cases 1:1 for sex and timing of FMT±1 month.
Overall, 522 patients underwent FMT; 70 [13.4%; median age 53.8 years (range, 18 to 89 y), 54.3% females] recurred within a median 5.6 months (range, 0.2 to 34.9 mo). Number of prior CDI episodes, prior CDI treatment, and prior CDI-related hospitalizations were similar in cases and controls. Systemic antibiotics after FMT (54.3% vs. 21.4%, P<0.0001), inflammatory bowel disease (IBD) (34.3% vs. 15.7%, P=0.01), pseudomembranes at FMT (4.3% vs. 0%, P=0.03), and poor bowel preparation (68.5% vs. 31.4%, P=0.01) were associated with FMT failure. On multivariate analysis, IBD [odds ratio (OR) 4.34; 95% confidence interval (CI), 1.24-15.15], systemic antibiotics (OR 7.39; 95% CI, 3.02-18.07), and poor bowel preparation (OR 3.84; 95% CI, 1.59-9.28) predicted FMT failure with an area under the curve of 0.78. Among FMT failures, 37 (52.8%) were managed with antibiotics, 32 (45.7%) with repeat FMT after antibiotics and 1 with colectomy.
Use of systemic antibiotics, IBD, and poor bowel preparation predict FMT failure. Patients with FMT failure can be managed with antibiotics and/or repeat FMT.
粪菌移植（FMT）后，艰难梭菌感染（CDI）的复发率为 10%至 15%。我们确定了预测因子，并描述了 FMT 后复发性 CDI 患者的管理和结局，这些患者主要是在门诊接受治疗。
对 2012 年 8 月至 2017 年 1 月期间因复发性 CDI 接受 FMT 的患者进行了一项嵌套病例对照研究。FMT 失败定义为在随访期间（≥2 个月）出现腹泻和粪便艰难梭菌检测阳性。对照（FMT 无失败的患者）按性别和 FMT 的时间与病例 1:1 匹配（±1 个月）。
共有 522 例患者接受了 FMT；70 例（13.4%；中位年龄 53.8 岁（范围 18 至 89 岁），54.3%为女性）在中位 5.6 个月（范围 0.2 至 34.9 个月）内复发。病例组和对照组之间，既往 CDI 发作次数、既往 CDI 治疗和既往与 CDI 相关的住院治疗无差异。FMT 后使用全身性抗生素（54.3%比 21.4%，P<0.0001）、炎症性肠病（IBD）（34.3%比 15.7%，P=0.01）、FMT 时假膜（4.3%比 0%，P=0.03）和肠道准备不佳（68.5%比 31.4%，P=0.01）与 FMT 失败相关。多变量分析显示，IBD（比值比[OR]4.34；95%置信区间[CI]1.24-15.15）、全身性抗生素（OR 7.39；95%CI 3.02-18.07）和肠道准备不佳（OR 3.84；95%CI 1.59-9.28）可预测 FMT 失败，曲线下面积为 0.78。在 FMT 失败的患者中，37 例（52.8%）接受抗生素治疗，32 例（45.7%）在抗生素治疗后接受重复 FMT，1 例接受结肠切除术。
使用全身性抗生素、IBD 和肠道准备不佳可预测 FMT 失败。FMT 失败的患者可以用抗生素和/或重复 FMT 治疗。
