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Outcomes of Fecal Microbiota Transplantation for Clostridium difficile Infection in Patients with Inflammatory Bowel Disease

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Abstract

Background and Aims

Fecal microbiota transplantation (FMT) has recently been shown to be a promising therapy for recurrent and refractory Clostridium difficile infections (CDI) despite lack of protocol standardization. Patients with inflammatory bowel disease (IBD) present a particular challenge to CDI therapy as they are reported to have worse clinical outcomes, including higher colectomy rates and increased mortality. We aimed to assess the outcomes of FMT for recurrent CDI in patients with IBD at our healthcare system.

Methods

We constructed a retrospective cohort of all patients who underwent FMT at our healthcare system between December 2012 and May 2014. Patients with concurrent IBD were identified. We evaluated the differences in demographic and clinical characteristics, along with the outcomes to FMT between patients with IBD as compared to the general population.

Results

Over the study period, 201 patients underwent FMT of which 20 patients had concurrent IBD. Patients with IBD were younger but did not differ from the general population in terms of CDI risk factors or disease severity. The response to FMT and rate of CDI relapse in the IBD group were not statistically different compared to the rest of the cohort. The overall response rate in the IBD population was 75% at 12 weeks. Of the patients who failed FMT 4 of 5 patients had active or untreated IBD.

Conclusion

Fecal microbiota transplantation provides a good alternative treatment option with high success rates for recurrent or refractory Clostridium difficile infection in patients with well-controlled IBD who fail standard antimicrobial therapy.

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Author’s contribution

AM, KB, BH, NM, AJ and MR have made substantial contribution to conception of the study and interpretation of data. AM, BH, KB and MR were involved in drafting and reviewing the manuscript. All authors read and approved the final manuscript.

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Authors and Affiliations

  1. Department of Internal Medicine, CFP1, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI, 48202, USA

    Alireza Meighani, Benjamin R. Hart, Nichole Miller & Ajin John

  2. Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, 37232, USA

    Kassem Bourgi

  3. Division of Infectious Diseases, Henry Ford Hospital, Detroit, MI, 48202, USA

    Mayur Ramesh

Authors
  1. Alireza Meighani
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  2. Benjamin R. Hart
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  3. Kassem Bourgi
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  4. Nichole Miller
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  5. Ajin John
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  6. Mayur Ramesh
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Correspondence to Alireza Meighani.

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Meighani, A., Hart, B.R., Bourgi, K. et al. Outcomes of Fecal Microbiota Transplantation for Clostridium difficile Infection in Patients with Inflammatory Bowel Disease. Dig Dis Sci 62, 2870–2875 (2017). https://doi.org/10.1007/s10620-017-4580-4

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  • DOI: https://doi.org/10.1007/s10620-017-4580-4

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