Fecal Microbiota Transplantation for Recurrent Clostridium difficile Infection in the Elderly: Long-Term Outcomes and Microbiota Changes
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Background and Aims
Fecal microbiota transplantation (FMT) has become the cornerstone in management of recurrent Clostridium difficile infection (RCDI) in adults. However, data on efficacy, safety, long-term outcomes, and microbiota alterations are limited in elderly patients (>65 years).
Twenty-nine consecutive elderly patients with RCDI underwent FMT with combined jejunal and colonic method and monitored for long-term outcomes. Fecal samples from five elderly RCDI patients (G65) were subjected to genomic analysis before and after FMT, and microbiota changes were compared with matched RCDI patients below 65 years (L65).
FMT resulted in marked improvement in all clinical parameters, including abdominal pain, bloating, and diarrhea in all elderly RCDI patients. Fecal C. difficile toxin was positive in all 29 patients and turned negative in all 27 patients, who agreed to undergo this test after FMT. Statistically significant improvement in leukocytosis was noted (p < 0.05). Only adverse events reported were transient mild fever (2/29) and bloating (3/29). Long-term follow-up over 25.4 ± 12.8 months did not reveal any additional adverse events or RCDI recurrence. Genomic analysis suggested that overall microbiota diversity increased post-FMT in elderly RCDI patients. However, this response was less robust than the younger group. While Firmicutes did not change markedly, Proteobacteria decreased significantly in post-FMT samples in elderly RCDI patients.
These observations suggest that FMT in elderly patients with RCDI appears to be highly efficacious with no recurrence of infection over long-term follow-up. Alterations in microbiota in this group of patients are characterized by less robust increase in microbial diversity and marked reduction in phylum Proteobacteria.
KeywordsFecal microbiota transplantation Jejunal Colonic Clostridium difficile Geriatric Elderly Safety Efficacy Outcomes
This study was supported by the Gastroenterology Research Fund, Division of Gastroenterology, Department of Medicine, Sinai Hospital of Baltimore, Baltimore, MD (Contributors: Weinberg Foundation, Eric Cowan Fund, Friedman & Friedman Law Firm Fund through their grants to Drs. Dutta and Girotra), and the Institute for Genome Sciences, University of Maryland, Baltimore, MD.
Mohit Girotra, Shashank Garg and Rohit Anand were involved in study concept and design, acquisition of data, collection and storage of samples, analysis and interpretation of data, review of literature, and drafting of manuscript and participated in patient interviews. Yang Song performed the microbiota genomic analysis and analysis and interpretation of data and drafted the microbiota section of the manuscript. Sudhir Dutta was involved in study concept and design, critical revision of the manuscript for important intellectual content, obtained funding, administrative and material support and study supervision, performed the endoscopic procedures, and was in-charge of patient care and the study.
Compliance with ethical standards
Conflicts of interest
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