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Incidence of Bloodstream Infections, Length of Stay, and Survival in Patients With Recurrent C. difficile Infection Treated With FMT or Antibiotics
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- In this prospective cohort study of 290 patients with recurrent C. difficile infection, the authors assessed the incidence of primary bloodstream infection (BSI) in patients treated with FMT (n = 109) versus antibiotics (n = 181). Overall, 5 patients treated with FMT and 40 patients treated with antibiotics developed a BSI. In the FMT group, patients had 14 fewer days of hospitalization, the risk for BSI was 23 percentage points lower, and there was a 32-percentage point increase in overall survival compared with patients treated with antibiotics.
- The results show that patients with recurrent C. difficile infection who were treated with FMT had a lower risk for developing primary BSI.
abstract
This abstract is available on the publisher's site.
Access this abstract nowBackground
Clostridioides difficile infection (CDI) is a risk factor for bloodstream infection (BSI). Fecal microbiota transplantation (FMT) is more effective than antibiotics in treating recurrent CDI, but its efficacy in preventing CDI-related BSI is uncertain.
Objective
To assess incidence of primary BSI in patients with recurrent CDI treated with FMT versus antibiotics.
Design
Prospective cohort study. Patients treated with FMT and those treated with antibiotics were matched on propensity score.
Setting
Single academic medical center.
Patients
290 inpatients with recurrent CDI (57 patients per treatment in matched cohort).
Intervention
FMT or antibiotics.
Measurements
The primary outcome was primary BSI within 90 days. Secondary outcomes were length of hospitalization and overall survival (OS) at 90 days.
Results
Of the 290 patients, 109 were treated with FMT and 181 received antibiotics. Five patients in the FMT group and 40 in the antibiotic group developed BSI. Because of differences in the patients treated with FMT versus antibiotics in many baseline characteristics, including number of recurrences and CDI severity, comparative analyses were limited to the matched cohort. Risk for BSI was 23 percentage points (95% CI, 10 to 35 percentage points) lower in the FMT group; the FMT group also had 14 fewer days of hospitalization (CI, 9 to 20 fewer days) and a 32-percentage point increase in OS (CI, 16 to 47 percentage points) compared with the antibiotic group.
Limitation
Nonrandomized study with potential for unmeasured or residual confounding; limited generalizability of the propensity score-matched cohort.
Conclusion
In a propensity score-matched cohort, patients with recurrent CDI treated with FMT were less likely to develop primary BSI.
Additional Info
Disclosure statements are available on the authors' profiles:
Incidence of Bloodstream Infections, Length of Hospital Stay, and Survival in Patients With Recurrent Clostridioides difficile Infection Treated With Fecal Microbiota Transplantation or Antibiotics: A Prospective Cohort Study
Ann. Intern. Med 2019 Nov 05;[EPub Ahead of Print], G Ianiro, R Murri, GD Sciumè, M Impagnatiello, L Masucci, AC Ford, GR Law, H Tilg, M Sanguinetti, R Cauda, A Gasbarrini, M Fantoni, G CammarotaFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Randomized controlled trials and systematic reviews have shown that fecal microbiota transplantation (FMT) is an effective and safe treatment for recurrent Clostridioides difficile infection (rCDI). The recent study by Ianiro et al adds to the current literature the benefits of FMT compared with antibiotic for rCDI. The authors explored the occurrence of bloodstream infections (BSI) in patients treated with FMT or antibiotic therapy. They found a higher incidence of BSI in those who were treated with antibiotic therapy compared with FMT. Specifically, 31 patients in the antibiotic group developed bacteremia compared with 5 in the FMT group; 14 patients in the antibiotic group had fungal bloodstream infections, but there was no such occurrence in the FMT group. Despite using propensity-matched scoring, their analysis showed that the groups were uneven at baseline, which might confound the results. The mean length of hospitalization was lower in FMT-treated cohorts at 13.3 versus 29.7 days for individuals treated with antibiotics, for a difference of 14 days (CI, 9–20 days). In addition, there were significantly higher overall survival rates at 90 days in the FMT group. The results of this study provide reassurance that FMT is a superior treatment option to antibiotics for rCDI as long as the stool donors are rigorously screened.