Fecal microbiota transplant for treatment of clostridium difficile infection in immunocompromised patients

Colleen R. Kelly, Chioma Ihunnah, Monika Fischer, Alexander Khoruts, Christina Surawicz, Anita Afzali, Olga Aroniadis, Amy Barto, Thomas Borody, Andrea Giovanelli, Shelley Gordon, Michael Gluck, Elizabeth L. Hohmann, Dina Kao, John Y. Kao, Daniel P. McQuillen, Mark Mellow, Kevin M. Rank, Krishna Rao, Arnab Ray & 7 others Margot A. Schwartz, Namita Singh, Neil Stollman, David L. Suskind, Stephen M. Vindigni, Ilan Youngster, Lawrence Brandt

Research output: Contribution to journalArticle

276 Citations (Scopus)

Abstract

OBJECTIVES:Patients who are immunocompromised (IC) are at increased risk of Clostridium difficile infection (CDI), which has increased to epidemic proportions over the past decade. Fecal microbiota transplantation (FMT) appears effective for the treatment of CDI, although there is concern that IC patients may be at increased risk of having adverse events (AEs) related to FMT. This study describes the multicenter experience of FMT in IC patients.METHODS:A multicenter retrospective series was performed on the use of FMT in IC patients with CDI that was recurrent, refractory, or severe. We aimed to describe rates of CDI cure after FMT as well as AEs experienced by IC patients after FMT. A 32-item questionnaire soliciting demographic and pre- and post-FMT data was completed for 99 patients at 16 centers, of whom 80 were eligible for inclusion. Outcomes included (i) rates of CDI cure after FMT, (ii) serious adverse events (SAEs) such as death or hospitalization within 12 weeks of FMT, (iii) infection within 12 weeks of FMT, and (iv) AEs (related and unrelated) to FMT.RESULTS:Cases included adult (75) and pediatric (5) patients treated with FMT for recurrent (55%), refractory (11%), and severe and/or overlap of recurrent/refractory and severe CDI (34%). In all, 79% were outpatients at the time of FMT. The mean follow-up period between FMT and data collection was 11 months (range 3-46 months). Reasons for IC included: HIV/AIDS (3), solid organ transplant (19), oncologic condition (7), immunosuppressive therapy for inflammatory bowel disease (IBD; 36), and other medical conditions/medications (15). The CDI cure rate after a single FMT was 78%, with 62 patients suffering no recurrence at least 12 weeks post FMT. Twelve patients underwent repeat FMT, of whom eight had no further CDI. Thus, the overall cure rate was 89%. Twelve (15%) had any SAE within 12 weeks post FMT, of which 10 were hospitalizations. Two deaths occurred within 12 weeks of FMT, one of which was the result of aspiration during sedation for FMT administered via colonoscopy; the other was unrelated to FMT. None suffered infections definitely related to FMT, but two patients developed unrelated infections and five had self-limited diarrheal illness in which no causal organism was identified. One patient had a superficial mucosal tear caused by the colonoscopy performed for the FMT, and three patients reported mild, self-limited abdominal discomfort post FMT. Five (14% of IBD patients) experienced disease flare post FMT. Three ulcerative colitis (UC) patients underwent colectomy related to course of UC >100 days after FMT.CONCLUSIONS:This series demonstrates the effective use of FMT for CDI in IC patients with few SAEs or related AEs. Importantly, there were no related infectious complications in these high-risk patients.

Original languageEnglish
Pages (from-to)1065-1071
Number of pages7
JournalAmerican Journal of Gastroenterology
Volume109
Issue number7
DOIs
StatePublished - 2014

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Clostridium Infections
Clostridium difficile
Microbiota
Immunocompromised Host
Therapeutics
Fecal Microbiota Transplantation
Colonoscopy
Ulcerative Colitis

ASJC Scopus subject areas

  • Gastroenterology

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Fecal microbiota transplant for treatment of clostridium difficile infection in immunocompromised patients. / Kelly, Colleen R.; Ihunnah, Chioma; Fischer, Monika; Khoruts, Alexander; Surawicz, Christina; Afzali, Anita; Aroniadis, Olga; Barto, Amy; Borody, Thomas; Giovanelli, Andrea; Gordon, Shelley; Gluck, Michael; Hohmann, Elizabeth L.; Kao, Dina; Kao, John Y.; McQuillen, Daniel P.; Mellow, Mark; Rank, Kevin M.; Rao, Krishna; Ray, Arnab; Schwartz, Margot A.; Singh, Namita; Stollman, Neil; Suskind, David L.; Vindigni, Stephen M.; Youngster, Ilan; Brandt, Lawrence.

In: American Journal of Gastroenterology, Vol. 109, No. 7, 2014, p. 1065-1071.

Research output: Contribution to journalArticle

Kelly, CR, Ihunnah, C, Fischer, M, Khoruts, A, Surawicz, C, Afzali, A, Aroniadis, O, Barto, A, Borody, T, Giovanelli, A, Gordon, S, Gluck, M, Hohmann, EL, Kao, D, Kao, JY, McQuillen, DP, Mellow, M, Rank, KM, Rao, K, Ray, A, Schwartz, MA, Singh, N, Stollman, N, Suskind, DL, Vindigni, SM, Youngster, I & Brandt, L 2014, 'Fecal microbiota transplant for treatment of clostridium difficile infection in immunocompromised patients', American Journal of Gastroenterology, vol. 109, no. 7, pp. 1065-1071. https://doi.org/10.1038/ajg.2014.133
Kelly, Colleen R. ; Ihunnah, Chioma ; Fischer, Monika ; Khoruts, Alexander ; Surawicz, Christina ; Afzali, Anita ; Aroniadis, Olga ; Barto, Amy ; Borody, Thomas ; Giovanelli, Andrea ; Gordon, Shelley ; Gluck, Michael ; Hohmann, Elizabeth L. ; Kao, Dina ; Kao, John Y. ; McQuillen, Daniel P. ; Mellow, Mark ; Rank, Kevin M. ; Rao, Krishna ; Ray, Arnab ; Schwartz, Margot A. ; Singh, Namita ; Stollman, Neil ; Suskind, David L. ; Vindigni, Stephen M. ; Youngster, Ilan ; Brandt, Lawrence. / Fecal microbiota transplant for treatment of clostridium difficile infection in immunocompromised patients. In: American Journal of Gastroenterology. 2014 ; Vol. 109, No. 7. pp. 1065-1071.
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abstract = "OBJECTIVES:Patients who are immunocompromised (IC) are at increased risk of Clostridium difficile infection (CDI), which has increased to epidemic proportions over the past decade. Fecal microbiota transplantation (FMT) appears effective for the treatment of CDI, although there is concern that IC patients may be at increased risk of having adverse events (AEs) related to FMT. This study describes the multicenter experience of FMT in IC patients.METHODS:A multicenter retrospective series was performed on the use of FMT in IC patients with CDI that was recurrent, refractory, or severe. We aimed to describe rates of CDI cure after FMT as well as AEs experienced by IC patients after FMT. A 32-item questionnaire soliciting demographic and pre- and post-FMT data was completed for 99 patients at 16 centers, of whom 80 were eligible for inclusion. Outcomes included (i) rates of CDI cure after FMT, (ii) serious adverse events (SAEs) such as death or hospitalization within 12 weeks of FMT, (iii) infection within 12 weeks of FMT, and (iv) AEs (related and unrelated) to FMT.RESULTS:Cases included adult (75) and pediatric (5) patients treated with FMT for recurrent (55{\%}), refractory (11{\%}), and severe and/or overlap of recurrent/refractory and severe CDI (34{\%}). In all, 79{\%} were outpatients at the time of FMT. The mean follow-up period between FMT and data collection was 11 months (range 3-46 months). Reasons for IC included: HIV/AIDS (3), solid organ transplant (19), oncologic condition (7), immunosuppressive therapy for inflammatory bowel disease (IBD; 36), and other medical conditions/medications (15). The CDI cure rate after a single FMT was 78{\%}, with 62 patients suffering no recurrence at least 12 weeks post FMT. Twelve patients underwent repeat FMT, of whom eight had no further CDI. Thus, the overall cure rate was 89{\%}. Twelve (15{\%}) had any SAE within 12 weeks post FMT, of which 10 were hospitalizations. Two deaths occurred within 12 weeks of FMT, one of which was the result of aspiration during sedation for FMT administered via colonoscopy; the other was unrelated to FMT. None suffered infections definitely related to FMT, but two patients developed unrelated infections and five had self-limited diarrheal illness in which no causal organism was identified. One patient had a superficial mucosal tear caused by the colonoscopy performed for the FMT, and three patients reported mild, self-limited abdominal discomfort post FMT. Five (14{\%} of IBD patients) experienced disease flare post FMT. Three ulcerative colitis (UC) patients underwent colectomy related to course of UC >100 days after FMT.CONCLUSIONS:This series demonstrates the effective use of FMT for CDI in IC patients with few SAEs or related AEs. Importantly, there were no related infectious complications in these high-risk patients.",
author = "Kelly, {Colleen R.} and Chioma Ihunnah and Monika Fischer and Alexander Khoruts and Christina Surawicz and Anita Afzali and Olga Aroniadis and Amy Barto and Thomas Borody and Andrea Giovanelli and Shelley Gordon and Michael Gluck and Hohmann, {Elizabeth L.} and Dina Kao and Kao, {John Y.} and McQuillen, {Daniel P.} and Mark Mellow and Rank, {Kevin M.} and Krishna Rao and Arnab Ray and Schwartz, {Margot A.} and Namita Singh and Neil Stollman and Suskind, {David L.} and Vindigni, {Stephen M.} and Ilan Youngster and Lawrence Brandt",
year = "2014",
doi = "10.1038/ajg.2014.133",
language = "English",
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pages = "1065--1071",
journal = "American Journal of Gastroenterology",
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TY - JOUR

T1 - Fecal microbiota transplant for treatment of clostridium difficile infection in immunocompromised patients

AU - Kelly, Colleen R.

AU - Ihunnah, Chioma

AU - Fischer, Monika

AU - Khoruts, Alexander

AU - Surawicz, Christina

AU - Afzali, Anita

AU - Aroniadis, Olga

AU - Barto, Amy

AU - Borody, Thomas

AU - Giovanelli, Andrea

AU - Gordon, Shelley

AU - Gluck, Michael

AU - Hohmann, Elizabeth L.

AU - Kao, Dina

AU - Kao, John Y.

AU - McQuillen, Daniel P.

AU - Mellow, Mark

AU - Rank, Kevin M.

AU - Rao, Krishna

AU - Ray, Arnab

AU - Schwartz, Margot A.

AU - Singh, Namita

AU - Stollman, Neil

AU - Suskind, David L.

AU - Vindigni, Stephen M.

AU - Youngster, Ilan

AU - Brandt, Lawrence

PY - 2014

Y1 - 2014

N2 - OBJECTIVES:Patients who are immunocompromised (IC) are at increased risk of Clostridium difficile infection (CDI), which has increased to epidemic proportions over the past decade. Fecal microbiota transplantation (FMT) appears effective for the treatment of CDI, although there is concern that IC patients may be at increased risk of having adverse events (AEs) related to FMT. This study describes the multicenter experience of FMT in IC patients.METHODS:A multicenter retrospective series was performed on the use of FMT in IC patients with CDI that was recurrent, refractory, or severe. We aimed to describe rates of CDI cure after FMT as well as AEs experienced by IC patients after FMT. A 32-item questionnaire soliciting demographic and pre- and post-FMT data was completed for 99 patients at 16 centers, of whom 80 were eligible for inclusion. Outcomes included (i) rates of CDI cure after FMT, (ii) serious adverse events (SAEs) such as death or hospitalization within 12 weeks of FMT, (iii) infection within 12 weeks of FMT, and (iv) AEs (related and unrelated) to FMT.RESULTS:Cases included adult (75) and pediatric (5) patients treated with FMT for recurrent (55%), refractory (11%), and severe and/or overlap of recurrent/refractory and severe CDI (34%). In all, 79% were outpatients at the time of FMT. The mean follow-up period between FMT and data collection was 11 months (range 3-46 months). Reasons for IC included: HIV/AIDS (3), solid organ transplant (19), oncologic condition (7), immunosuppressive therapy for inflammatory bowel disease (IBD; 36), and other medical conditions/medications (15). The CDI cure rate after a single FMT was 78%, with 62 patients suffering no recurrence at least 12 weeks post FMT. Twelve patients underwent repeat FMT, of whom eight had no further CDI. Thus, the overall cure rate was 89%. Twelve (15%) had any SAE within 12 weeks post FMT, of which 10 were hospitalizations. Two deaths occurred within 12 weeks of FMT, one of which was the result of aspiration during sedation for FMT administered via colonoscopy; the other was unrelated to FMT. None suffered infections definitely related to FMT, but two patients developed unrelated infections and five had self-limited diarrheal illness in which no causal organism was identified. One patient had a superficial mucosal tear caused by the colonoscopy performed for the FMT, and three patients reported mild, self-limited abdominal discomfort post FMT. Five (14% of IBD patients) experienced disease flare post FMT. Three ulcerative colitis (UC) patients underwent colectomy related to course of UC >100 days after FMT.CONCLUSIONS:This series demonstrates the effective use of FMT for CDI in IC patients with few SAEs or related AEs. Importantly, there were no related infectious complications in these high-risk patients.

AB - OBJECTIVES:Patients who are immunocompromised (IC) are at increased risk of Clostridium difficile infection (CDI), which has increased to epidemic proportions over the past decade. Fecal microbiota transplantation (FMT) appears effective for the treatment of CDI, although there is concern that IC patients may be at increased risk of having adverse events (AEs) related to FMT. This study describes the multicenter experience of FMT in IC patients.METHODS:A multicenter retrospective series was performed on the use of FMT in IC patients with CDI that was recurrent, refractory, or severe. We aimed to describe rates of CDI cure after FMT as well as AEs experienced by IC patients after FMT. A 32-item questionnaire soliciting demographic and pre- and post-FMT data was completed for 99 patients at 16 centers, of whom 80 were eligible for inclusion. Outcomes included (i) rates of CDI cure after FMT, (ii) serious adverse events (SAEs) such as death or hospitalization within 12 weeks of FMT, (iii) infection within 12 weeks of FMT, and (iv) AEs (related and unrelated) to FMT.RESULTS:Cases included adult (75) and pediatric (5) patients treated with FMT for recurrent (55%), refractory (11%), and severe and/or overlap of recurrent/refractory and severe CDI (34%). In all, 79% were outpatients at the time of FMT. The mean follow-up period between FMT and data collection was 11 months (range 3-46 months). Reasons for IC included: HIV/AIDS (3), solid organ transplant (19), oncologic condition (7), immunosuppressive therapy for inflammatory bowel disease (IBD; 36), and other medical conditions/medications (15). The CDI cure rate after a single FMT was 78%, with 62 patients suffering no recurrence at least 12 weeks post FMT. Twelve patients underwent repeat FMT, of whom eight had no further CDI. Thus, the overall cure rate was 89%. Twelve (15%) had any SAE within 12 weeks post FMT, of which 10 were hospitalizations. Two deaths occurred within 12 weeks of FMT, one of which was the result of aspiration during sedation for FMT administered via colonoscopy; the other was unrelated to FMT. None suffered infections definitely related to FMT, but two patients developed unrelated infections and five had self-limited diarrheal illness in which no causal organism was identified. One patient had a superficial mucosal tear caused by the colonoscopy performed for the FMT, and three patients reported mild, self-limited abdominal discomfort post FMT. Five (14% of IBD patients) experienced disease flare post FMT. Three ulcerative colitis (UC) patients underwent colectomy related to course of UC >100 days after FMT.CONCLUSIONS:This series demonstrates the effective use of FMT for CDI in IC patients with few SAEs or related AEs. Importantly, there were no related infectious complications in these high-risk patients.

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