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Fecal Transplantation for CDI Is Safe and Effective in Immunocompromised Patients

August 5, 2014

Fecal Transplantation for CDI Is Safe and Effective in Immunocompromised Patients

  1. Douglas K. Rex, MD

The overall cure rate was 89%, with one death occurring from aspiration.

  1. Douglas K. Rex, MD

Given that immunocompromised patients are at increased risk for infection, is it safe to perform fecal microbiota transplantation for treatment of Clostridium difficile infection (CDI) in this population? Researchers addressed this question — as well as the effectiveness of fecal transplantation in this setting — in a multicenter, retrospective trial of 99 patients at 16 centers.

In the 80 patients eligible for inclusion, reasons for immunocompromised status were immunosuppressive therapy for inflammatory bowel disease (36 patients), organ transplantation (19), cancer (7), HIV/AIDS (3), and other medical conditions or medications (15). A single fecal transplantation resulted in cure in 62 patients (78%), who had no recurrence at 12 weeks posttransplantation. A second transplantation was performed in 12 patients, of whom 8 were cured, for an overall cure rate of 89%. Twelve patients experienced serious adverse events within 12 weeks; 10 patients were hospitalized, and 2 died. One death resulted from aspiration during sedation for fecal transplantation administered by colonoscopy. No infections were definitely attributed to colonoscopy.

Comment

These results indicate that fecal transplantation is safe and effective for the treatment of recurrent or refractory CDI in immunocompromised patients.

  • Disclosures for Douglas K. Rex, MD at time of publication Consultant / Advisory board Given Imaging; Olympus Corporation America; Exact Sciences; Endo Aid Speaker’s bureau Boston Scientific; Braintree Laboratories; Ferring Pharmaceuticals; Olympus America Grant / Research support CDC; Olympus America; Boston Medical Center Editorial boards World Journal of Gastroenterology; The Journal of Clinical Gastroenterology; Techniques in Gastrointestinal Endoscopy; Gastroenterology & Hepatology; Expert Review of Gastroenterology & Hepatology; Medscape Gastroenterology; World Journal of Gastrointestinal Pharmacology and Therapeutics; Annals of Gastroenterology & Hepatology; World Journal of Gastrointestinal Oncology; Comparative Effectiveness Research; Journal of Anesthesia & Clinical Research; Gastroenterology; World Journal of Gastrointestinal Pathophysiology; Gastroenterology Research and Practice; GI & Hepatology News; Gastroenterology Report; Clinical Epidemiology Reviews; JSM Gastroenterology and Hepatology Leadership positions in professional societies American Society for Gastrointestinal Endoscopy (Councilor); US Multi-Society Task Forces (AGA, ACG, ASGE) (Chair)

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