Relationship of symptom duration and fecal bacteriotherapy in Clostridium difficile infection-pooled data analysis and a systematic review

Abstract

Objective. Clostridium difficle-associated infection (CDI) is usually treated with antibiotics; nevertheless, the infection has a high relapse rate. Case series and case reports using fecal microbiota transplant (FMT) for CDI show promising results. However, there are no large studies to provide evidence for the efficacy of this therapy. The aim of this pooled patient data meta-analysis was to determine the efficacy of FMT in CDI. Methods. We performed a literature search for FMT for CDI or pseudomembranous colitis. Individual patient data were obtained from each study. The primary endpoint was to assess the rate of diarrhea resolution. Secondary endpoints were to identify variables associated with treatment failure and side effects of therapy. Results. A total of 289 patients from 25 published articles who received FMT for CDI were included in the pooled data analysis. FMT had an overall success rate of 91.2%. On univariate analysis, shorter duration of symptoms before FMT (< 60 days) and gastroduodenal route of fecal instillation were associated with treatment failure. On multivariate regression analysis, shorter duration of symptoms (< 60 days) before the FMT (OR= 11.08; p = 0.0009) was associated with treatment failure. Reported adverse events following FMT were irritable bowel syndrome (n = 1), symptoms of mild enteritis (n = 3), and suspected peritonitis following the procedure (n = 1). Conclusion. FMT is a safe and effective treatment option for CDI. Shorter duration of symptoms (< 60 days) before administering FMT is associated with treatment failure.

Key Words::

• Anorectal-diseases
• GI infections

Acknowledgment

We thank Prof. Mark Mellow, Dr. Pavel Polak, and Prof Alistair MacConnachie for sharing the patient data with us.

Declaration of interest: Aijaz Sofi – none. Ann Silverman – an investigator for Abbott Labs, Takeda Pharmaceuticals, Furiex Pharmaceuticals, Amgen, Cubist Pharmaceuticals, ViroPharma, Genzyme, Salix, Optimer, Prometheus. In addition, this trial was funded by Takeda Pharmaceuticals Inc. Sadik Khuder – none. Kjetil Garborg – none. Julie Silverman – none. Ali Nawras – none.