Race, Medication History Predict Risk for Requiring FMT in Clostridium difficile

Seah H. Lim, MD, PhD, Division of Hematology and Oncology, Rhode Island Hospital

Seah H. Lim, MD, PhD

Race, metronidazole, immunosuppressive therapy use, comorbidities and concomitant inflammatory bowel disease (IBD) are factors that may predict the need for fecal microbiota transplantation (FMT) among patients presenting with recurrent Clostridium difficile (C. difficile) infections, according to findings from a retrospective study published in Infection Control & Hospital Epidemiology.¹

“Identification of these risk factors and clinical characteristics will provide insights into not only approaches to negate the risk factors but also the design of novel strategies to increase accessibility to this therapeutic approach,” lead author Seah Lim, MD, PhD, and researchers commented in regard to the FMT findings.

In this single-center cohort, investigators compared adult patients who received FMT for recurrent C. difficile infection (CDI) (n = 200) with CDI patients who did not undergo transplantation (n = 75). Electronic medical records of inpatients at an academic teaching medical center between 2006 and 2016 were used to obtain patient data. Individuals were included in this study if they had ≥3 CDI episodes during the study period.

A univariate analysis found that patients with a history of immunosuppressive therapy (odds ratio [OR], 3.4; 95% CI 1—11.6, P =.04) and metronidazole (OR, 8.5, 95% CI 1—66, P =.02) use as well as those with concomitant IBD (OR 5.8; 95% CI 1.7—19.3, P =.002) had a greater likelihood of undergoing FMT. In the univariate and multivariate analyses, patients who used oral vancomycin for their first CDI were more likely to require FMT than those who did not use this therapy (P =.02 and P =.03, respectively). Conversely, the intravenous use of vancomycin <2 months prior to the first CDI correlated with a lower risk for FMT in the univariate (OR 0.08, 95% CI 0.03—0.24, P =.000003) and multivariate (P =.0001) analyses.

Also, individuals who received oral vancomycin for the first CDI event had a greater need for FMT when compared with oral or intravenous metronidazole therapy (OR 1.9, 95% CI 1.1—3.4, P =.02) if these patients developed recurrent CDI. Additionally, participants who underwent FMT experienced a significantly shorter duration between the first CDI and the second CDI event compared with patients who experienced CDI but did not undergo FMT (P =.00004).

Patients with recurrent CDI who were black had a lower chance of undergoing FMT than white patients (P =.00005). The investigators suggest that this discrepancy was primarily “due to differences in the access of FMT between blacks and whites, which may be caused by disparities such as health insurance coverage, clinical access and adequacy of long-term follow-up.”

The presence of comorbidities, particularly chronic renal disease, congestive heart failure, diabetes mellitus, cancer, chronic obstructive pulmonary disease and myocardial infarction, was also associated with a lower chance of undergoing FMT.

The researchers conclude that “appropriate education provided to referring physicians may increase the access” of FMT to patients with comorbidities.

“Our findings should serve as a platform to alter the management of patients with CDI to negate their risk factors for recurrent infection,” added study investigators.

REFERENCE

1. Jamot S, Raghunathan V, Patel K, Kelly CR, Lim SH. Factors Associated with the Use of Fecal Microbiota Transplant in Patients with Recurrent Clostridium difficile Infections [published online January 24, 2018]. Infect Control Hosp Epidemiol. doi:10.1017/ice.2017.314.

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