Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA.
Clin Infect Dis. 2021 Oct 5;73(7):e1706-e1712. doi: 10.1093/cid/ciaa1457.
Fecal microbiota transplantation (FMT) is highly effective for preventing recurrent Clostridioides difficile infection (CDI). Durability (no recurrence despite additional risk factor exposure) of FMT protection is largely unknown. We studied the durability of FMT in patients with recurrent CDI.
We conducted a retrospective study of adults undergoing FMT for recurrent CDI. Data collected included demographics, CDI risk factors (comorbidities, healthcare exposure, non-CDI antibiotic use, acid suppressant medications), and future CDI episodes. Durable response to FMT was defined as lack of CDI episodes within 1 year post-FMT despite risk factor exposure.
Overall, 460 patients were included (median age, 57 years [18-94]; 65.2% female). Comorbidities included chronic liver disease, 12.8% (n = 59); cancer, 11.7% (n = 54); chronic kidney disease, 3.9% (n = 18); and inflammatory bowel disease, 21.9% (n = 101). Overall, 31.3% (n = 144) received antibiotics, 21.7% (n = 100) received acid suppressants, and 76.8% (n = 350) had healthcare exposure after FMT. Of 374 patients with risk factor exposure, 78.1% (95% confidence interval [CI], 72.7%-84.0%) had durable response to FMT at 1 year. On multivariable analysis, antibiotic use was independently associated with decreased durability of FMT (hazard ratio, 0.27; 95% CI, .15-.49; P < .001).
The majority of patients had a durable response to FMT despite exposure to CDI risk factors. Antibiotic exposure after FMT independently predicted loss of durability of FMT. Larger studies are needed to define predictors of durable response in patients with and without exposure to antibiotics.
粪便微生物移植（FMT）对于预防复发性艰难梭菌感染（CDI）非常有效。FMT 保护的持久性（尽管存在额外的危险因素暴露，但无复发）在很大程度上尚不清楚。我们研究了 FMT 在复发性 CDI 患者中的持久性。
我们对接受 FMT 治疗复发性 CDI 的成年人进行了回顾性研究。收集的数据包括人口统计学资料、CDI 危险因素（合并症、医疗保健暴露、非 CDI 抗生素使用、抑酸药物）和未来的 CDI 发作。FMT 的持久反应定义为在 FMT 后 1 年内尽管存在危险因素暴露，但无 CDI 发作。
总共纳入 460 例患者（中位年龄 57 岁[18-94]；65.2%为女性）。合并症包括慢性肝病，占 12.8%（n=59）；癌症，占 11.7%（n=54）；慢性肾脏病，占 3.9%（n=18）；炎症性肠病，占 21.9%（n=101）。总体而言，31.3%（n=144）接受了抗生素治疗，21.7%（n=100）接受了抑酸药物治疗，76.8%（n=350）在 FMT 后有医疗保健暴露。在 374 例有危险因素暴露的患者中，78.1%（95%置信区间[CI]，72.7%-84.0%）在 1 年时有持久的 FMT 反应。多变量分析显示，抗生素使用与 FMT 持久性降低独立相关（风险比，0.27；95%CI，0.15-0.49；P<0.001）。
尽管存在 CDI 危险因素暴露，但大多数患者对 FMT 有持久的反应。FMT 后抗生素暴露独立预测 FMT 持久性丧失。需要更大规模的研究来确定有和没有抗生素暴露的患者中持久反应的预测因素。
