Montalto Massimo, Gallo Antonella, Agnitelli Maria Chiara, Pellegrino Simona, Lipari Alice, Pero Erika, Covino Marcello, Landi Francesco, Gasbarrini Antonio, Cammarota Giovanni, Ianiro Gianluca
Department of Geriatrics and Orthopedics, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.
Department of Geriatrics and Orthopedics, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
J Am Geriatr Soc. 2023 Nov;71(11):3530-3537. doi: 10.1111/jgs.18500. Epub 2023 Jul 17.
Older age is a well-known risk factor for recurrent and severe Clostridioides difficile infection (CDI). Fecal microbiota transplantation (FMT) is widely recognized as an effective and safe therapeutic option for the treatment of recurrent CDI (rCDI). However, the efficacy and safety of FMT for rCDI in very old patients are uncertain. This study evaluated the efficacy and safety of FMT in a group of very old subjects with rCDI, and the reliability of overall comorbidity and frailty assessment for identifying patients at higher risk of worse clinical outcomes.
This is a retrospective single-center study including patients ≥85 years undergoing FMT for rCDI between 2014 and 2022. Primary outcomes included efficacy of FMT, defined as cure of CDI at 8 week-follow-up, and safety evaluation. At baseline, comorbidity was measured with the Charlson Comorbidity Index (CCI). Frailty was measured with the Clinical Frailty Scale (CFS).
Overall, 43 patients with a median age of 88 years underwent FMT by colonoscopy in the study period. The rate of first FMT success was 77%. Five of the 10 patients who failed the first FMT infusion were cured after repeat FMT, with an overall efficacy of 88%. In patients with successful treatment, the CFS was significantly lower compared to those who failed the FMT or underwent repeat FMT (p < 0.01 for both). Mild adverse events occurred in 11 patients (25%). One death, not related to FMT or rCDI, occurred within 7 days from the first procedure.
FMT is effective and safe in very old patients. Frailty and high comorbidity do not limit use of FMT in these patients. Frailty assessment has potential to better identify patients at higher risk of worse outcomes or for repeat treatment with FMT.
高龄是复发性及严重艰难梭菌感染（CDI）的一个众所周知的风险因素。粪便微生物群移植（FMT）被广泛认为是治疗复发性CDI（rCDI）的一种有效且安全的治疗选择。然而，FMT用于极老年患者rCDI的疗效和安全性尚不确定。本研究评估了FMT在一组极老年rCDI患者中的疗效和安全性，以及总体合并症和衰弱评估对于识别临床结局较差风险较高患者的可靠性。
这是一项回顾性单中心研究，纳入了2014年至2022年间因rCDI接受FMT的≥85岁患者。主要结局包括FMT的疗效（定义为8周随访时CDI治愈）和安全性评估。在基线时，使用Charlson合并症指数（CCI）测量合并症。使用临床衰弱量表（CFS）测量衰弱程度。
总体而言，在研究期间，43名中位年龄为88岁的患者通过结肠镜检查接受了FMT。首次FMT成功的比例为77%。首次FMT输注失败的10名患者中有5名在重复FMT后治愈，总体有效率为88%。在治疗成功的患者中，CFS显著低于FMT失败或接受重复FMT的患者（两者均p < 0.01）。11名患者（25%）发生了轻度不良事件。在首次手术后7天内发生了1例与FMT或rCDI无关的死亡。
FMT在极老年患者中有效且安全。衰弱和高合并症并不限制在这些患者中使用FMT。衰弱评估有可能更好地识别结局较差风险较高或需要重复FMT治疗的患者。
