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Predictors of failure after fecal microbiota transplantation for recurrent Clostridioides difficile infection: a systematic review and meta-analysis

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Abstract

Fecal microbiota transplantation (FMT) is a highly effective therapy for recurrent Clostridioides difficile infection (CDI), with ~15% 1-year recurrence rate. Small studies have identified variable risk factors associated with FMT failure. We, therefore, performed a systematic review and meta-analysis to evaluate the predictors of FMT failure. A systematic search of Medline, Embase, and Web of Science was performed from January 2013 up to June 2020. Meta-analyses were performed using random-effects models and pooled adjusted odds ratios for risk factors reported in ≥2 studies were calculated. Overall, 2671 patients with recurrent CDI who underwent FMT in 12 studies were included. FMT failure occurred in 454 patients (16.9%) with median follow-up of 3 months (range 2–7.7 months). A total of 9 risk factors were identified in ≥2 studies. Meta-analysis showed that use of non- CDI antibiotics, presence of inflammatory bowel disease, poor quality of bowel preparation, CDI-related hospitalization before FMT, inpatient FMT, and severe CDI were associated with statistically significant increased risk of failure after FMT. Increasing age, female gender, and immunocompromised status were not associated with increased risk for FMT failure. Several risk factors (both modifiable and non-modifiable) are associated with FMT failure. Lower use of antibiotics in the post-FMT period and good bowel preparation at the time of FMT are associated with lower risk of failure after FMT. Additionally, patients with non-modifiable risk factors should be counseled to be particularly alert about recurrent symptoms after FMT.

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Raseen Tariq, Darrell Pardi & Sahil Khanna

  2. Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA

    Raseen Tariq

  3. Department of Internal Medicine, University of Oklahoma, Norman, OK, USA

    Maham Hayat

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Contributions

R.T.: Concept, data interpretation, drafting and revision of the manuscript, M.H.: Drafting and revision of the manuscript, D.S.P.: Drafting and revision of the manuscript, S.K.: Concept, data interpretation, drafting and revision of the manuscript. All authors approved the final version of the article, including the authorship list.

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Correspondence to Sahil Khanna.

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Sahil Khanna.

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Tariq, R., Hayat, M., Pardi, D. et al. Predictors of failure after fecal microbiota transplantation for recurrent Clostridioides difficile infection: a systematic review and meta-analysis. Eur J Clin Microbiol Infect Dis 40, 1383–1392 (2021). https://doi.org/10.1007/s10096-021-04163-z

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