Recurrent Clostridioides difficile Infection and Outcome of Fecal Microbiota Transplantation Use: A Population-Based Assessment

• Type of Material: Article
• Authors: Nirja Mehta, Emory University; Dana Goodenough, Emory University; Nitin K. Gupta, Atlanta Gastroenterology Associates; Stepy Thomas, Emory University; Christina Mehta, Emory University; Radhika Prakash Asrani, Emory University; Michael Woodworth, Emory University; Colleen S Kraft, Emory University; Scott Fridkin, Emory University
• Language: English
• Date: 2024-07
• Publisher: Oxford University Press
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): https://doi.org/10.1093%2Fofid%2Fofae309
• Title of Journal or Parent Work: Open Forum Infectious Diseases
• Volume: 11
• Issue: 7
• Start Page: ofae309
• Grant/Funding Information: This work was supported by the Georgia Clinical and Translational Science Alliance (TL1 program grants TL1TR002382 and UL1TR002378 to N. M.), the Centers for Disease Control and Prevention’s Emerging Infections Program (grant U50CK000485 funding EIP surveillance), and the National Institute of Allergy and Infectious Diseases (grant K23AI144036 to M. H. W.).
• Keywords: real-world therapy utilization; emerging infections program; clostridioides difficile; difficile; fecal microbiota transplantation; recurrent clostridioides
• Research Categories: Health Sciences, Health Care Management; Biology, Virology

Abstract

Background Fecal microbiota transplantation (FMT) is recommended for the treatment of recurrent Clostridioides difficile infection (rCDI). In the current study, we evaluated rates of rCDI and subsequent FMT in a large metropolitan area. We compared demographic and clinical differences in FMT recipients and nonrecipients and quantified differences in outcomes based on treatment modality. Methods A retrospective community-wide cohort study was conducted using surveillance data from the Georgia Emerging Infections Program, the Georgia Discharge Data System, and locally maintained lists of FMTs completed across multiple institutions to evaluate all episodes of C. difficile infection (CDI) in this region between 2016 and 2019. Cases were limited to patients with rCDI and ≥1 documented hospitalization. A propensity-matched cohort was created to compare rates of recurrence and mortality among matched patients based on FMT receipt. Results A total of 3038 (22%) of 13 852 patients with CDI had rCDI during this period. In a propensity-matched cohort, patients who received an FMT had lower rates of rCDI (odds ratio, 0.6 [95% confidence interval, .38–.96) and a lower mortality rate (0.26 [.08–.82]). Of patients with rCDI, only 6% had received FMT. Recipients were more likely to be young, white, and female and less likely to have renal disease, diabetes, or liver disease, though these chronic illnesses were associated with higher rates of rCDI. Conclusions These data suggest FMT has been underused in a population-based assessment and that FMT substantially reduced risk of recurrence and death.