Risk of Clostridium difficile Infection with Systemic Antimicrobial Therapy Following Successful Fecal Microbiota Transplant: Should We Recommend Anti-Clostridium difficile Antibiotic Prophylaxis?

Jessica R. Allegretti, Dina Kao, Emmalee Phelps, Brandi Roach, Justin Smith, Vincent C. Ganapini, Zain Kassam, Huiping Xu, Monika Fischer

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Introduction: The risk of a new Clostridium difficile infection (CDI) after FMT is unknown if non-CDI antibiotics are required. It is uncertain if anti-CDI prophylaxis or probiotics would reduce risk. We therefore aimed to compare the risk of CDI with and without antibiotic exposure and the benefit of concomitant anti-CDI antibiotic or probiotic prophylaxis. Methods: This is a multicenter retrospective study carried out at three large FMT referral centers of patients who underwent FMT for recurrent CDI. Patients were assessed for antibiotic use, as well as concomitant use of prophylactic anti-CDI antibiotics or probiotics. Time to CDI recurrence after FMT was evaluated using the Kaplan–Meier method. Results: A total of 404 patients were included: 63% were females, with a mean age of 61.3 ± 18.8 years. Mean length of post-FMT follow-up was 18.1 ± 11.9 months (range 2.2–45.2). Among the entire cohort 8.1% (n = 33) experienced a CDI recurrence. Overall, 111 patients (27.4%) used a non-CDI antibiotic, of which 16.2% (n = 18) experienced a CDI recurrence. Patients who used non-CDI antibiotics were more likely to develop CDI (HR 8.44, 95% CI 4.21–16.93, p < 0.001). The risk of CDI recurrence was not different between patients who received anti-CDI antibiotic prophylaxis to those who did not (HR = 1.88, 95% CI 0.72–4.86, p = 0.2); however, probiotic prophylaxis was associated with a greater risk of CDI recurrence (HR = 2.65, 95% CI 1.02–6.86, p = 0.045). Conclusion: Non-CDI antibiotic use was not uncommon after successful FMT and significantly increased the risk of a new episode of CDI. In this study, we found that the prophylactic use of anti-CDI antibiotics or probiotics was not protective.

Original languageEnglish (US)
JournalDigestive Diseases and Sciences
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Clostridium Infections
Antibiotic Prophylaxis
Clostridium difficile
Microbiota
Anti-Bacterial Agents
Probiotics
Therapeutics
Recurrence
Fecal Microbiota Transplantation
Infection

Keywords

  • C. difficile recurrence prevention
  • Clostridium difficile infection
  • Fecal microbiota transplantation
  • FMT
  • Systemic antibiotic

ASJC Scopus subject areas

  • Physiology
  • Gastroenterology

Cite this

Risk of Clostridium difficile Infection with Systemic Antimicrobial Therapy Following Successful Fecal Microbiota Transplant : Should We Recommend Anti-Clostridium difficile Antibiotic Prophylaxis? / Allegretti, Jessica R.; Kao, Dina; Phelps, Emmalee; Roach, Brandi; Smith, Justin; Ganapini, Vincent C.; Kassam, Zain; Xu, Huiping; Fischer, Monika.

In: Digestive Diseases and Sciences, 01.01.2019.

Research output: Contribution to journalArticle

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title = "Risk of Clostridium difficile Infection with Systemic Antimicrobial Therapy Following Successful Fecal Microbiota Transplant: Should We Recommend Anti-Clostridium difficile Antibiotic Prophylaxis?",
abstract = "Introduction: The risk of a new Clostridium difficile infection (CDI) after FMT is unknown if non-CDI antibiotics are required. It is uncertain if anti-CDI prophylaxis or probiotics would reduce risk. We therefore aimed to compare the risk of CDI with and without antibiotic exposure and the benefit of concomitant anti-CDI antibiotic or probiotic prophylaxis. Methods: This is a multicenter retrospective study carried out at three large FMT referral centers of patients who underwent FMT for recurrent CDI. Patients were assessed for antibiotic use, as well as concomitant use of prophylactic anti-CDI antibiotics or probiotics. Time to CDI recurrence after FMT was evaluated using the Kaplan–Meier method. Results: A total of 404 patients were included: 63{\%} were females, with a mean age of 61.3 ± 18.8 years. Mean length of post-FMT follow-up was 18.1 ± 11.9 months (range 2.2–45.2). Among the entire cohort 8.1{\%} (n = 33) experienced a CDI recurrence. Overall, 111 patients (27.4{\%}) used a non-CDI antibiotic, of which 16.2{\%} (n = 18) experienced a CDI recurrence. Patients who used non-CDI antibiotics were more likely to develop CDI (HR 8.44, 95{\%} CI 4.21–16.93, p < 0.001). The risk of CDI recurrence was not different between patients who received anti-CDI antibiotic prophylaxis to those who did not (HR = 1.88, 95{\%} CI 0.72–4.86, p = 0.2); however, probiotic prophylaxis was associated with a greater risk of CDI recurrence (HR = 2.65, 95{\%} CI 1.02–6.86, p = 0.045). Conclusion: Non-CDI antibiotic use was not uncommon after successful FMT and significantly increased the risk of a new episode of CDI. In this study, we found that the prophylactic use of anti-CDI antibiotics or probiotics was not protective.",
keywords = "C. difficile recurrence prevention, Clostridium difficile infection, Fecal microbiota transplantation, FMT, Systemic antibiotic",
author = "Allegretti, {Jessica R.} and Dina Kao and Emmalee Phelps and Brandi Roach and Justin Smith and Ganapini, {Vincent C.} and Zain Kassam and Huiping Xu and Monika Fischer",
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T1 - Risk of Clostridium difficile Infection with Systemic Antimicrobial Therapy Following Successful Fecal Microbiota Transplant

T2 - Should We Recommend Anti-Clostridium difficile Antibiotic Prophylaxis?

AU - Allegretti, Jessica R.

AU - Kao, Dina

AU - Phelps, Emmalee

AU - Roach, Brandi

AU - Smith, Justin

AU - Ganapini, Vincent C.

AU - Kassam, Zain

AU - Xu, Huiping

AU - Fischer, Monika

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Introduction: The risk of a new Clostridium difficile infection (CDI) after FMT is unknown if non-CDI antibiotics are required. It is uncertain if anti-CDI prophylaxis or probiotics would reduce risk. We therefore aimed to compare the risk of CDI with and without antibiotic exposure and the benefit of concomitant anti-CDI antibiotic or probiotic prophylaxis. Methods: This is a multicenter retrospective study carried out at three large FMT referral centers of patients who underwent FMT for recurrent CDI. Patients were assessed for antibiotic use, as well as concomitant use of prophylactic anti-CDI antibiotics or probiotics. Time to CDI recurrence after FMT was evaluated using the Kaplan–Meier method. Results: A total of 404 patients were included: 63% were females, with a mean age of 61.3 ± 18.8 years. Mean length of post-FMT follow-up was 18.1 ± 11.9 months (range 2.2–45.2). Among the entire cohort 8.1% (n = 33) experienced a CDI recurrence. Overall, 111 patients (27.4%) used a non-CDI antibiotic, of which 16.2% (n = 18) experienced a CDI recurrence. Patients who used non-CDI antibiotics were more likely to develop CDI (HR 8.44, 95% CI 4.21–16.93, p < 0.001). The risk of CDI recurrence was not different between patients who received anti-CDI antibiotic prophylaxis to those who did not (HR = 1.88, 95% CI 0.72–4.86, p = 0.2); however, probiotic prophylaxis was associated with a greater risk of CDI recurrence (HR = 2.65, 95% CI 1.02–6.86, p = 0.045). Conclusion: Non-CDI antibiotic use was not uncommon after successful FMT and significantly increased the risk of a new episode of CDI. In this study, we found that the prophylactic use of anti-CDI antibiotics or probiotics was not protective.

AB - Introduction: The risk of a new Clostridium difficile infection (CDI) after FMT is unknown if non-CDI antibiotics are required. It is uncertain if anti-CDI prophylaxis or probiotics would reduce risk. We therefore aimed to compare the risk of CDI with and without antibiotic exposure and the benefit of concomitant anti-CDI antibiotic or probiotic prophylaxis. Methods: This is a multicenter retrospective study carried out at three large FMT referral centers of patients who underwent FMT for recurrent CDI. Patients were assessed for antibiotic use, as well as concomitant use of prophylactic anti-CDI antibiotics or probiotics. Time to CDI recurrence after FMT was evaluated using the Kaplan–Meier method. Results: A total of 404 patients were included: 63% were females, with a mean age of 61.3 ± 18.8 years. Mean length of post-FMT follow-up was 18.1 ± 11.9 months (range 2.2–45.2). Among the entire cohort 8.1% (n = 33) experienced a CDI recurrence. Overall, 111 patients (27.4%) used a non-CDI antibiotic, of which 16.2% (n = 18) experienced a CDI recurrence. Patients who used non-CDI antibiotics were more likely to develop CDI (HR 8.44, 95% CI 4.21–16.93, p < 0.001). The risk of CDI recurrence was not different between patients who received anti-CDI antibiotic prophylaxis to those who did not (HR = 1.88, 95% CI 0.72–4.86, p = 0.2); however, probiotic prophylaxis was associated with a greater risk of CDI recurrence (HR = 2.65, 95% CI 1.02–6.86, p = 0.045). Conclusion: Non-CDI antibiotic use was not uncommon after successful FMT and significantly increased the risk of a new episode of CDI. In this study, we found that the prophylactic use of anti-CDI antibiotics or probiotics was not protective.

KW - C. difficile recurrence prevention

KW - Clostridium difficile infection

KW - Fecal microbiota transplantation

KW - FMT

KW - Systemic antibiotic

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