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Fecal Transplant Conquers C. Difficile in Long-Term Follow-up


 

FROM THE ANNUAL MEETING OF THE AMERICAN COLLEGE OF GASTROENTEROLOGY

NATIONAL HARBOR, MD – Fecal microbiota transplants showed long-term effectiveness in eliminating recurrent Clostridium difficile infections, based on data from 77 patients.

The findings were presented at the annual meeting of the American College of Gastroenterology.

C. difficile is responsible for approximately 500,000 infections and 15,000 deaths annually in the United States, said Dr. Mark Mellow, medical director of the digestive health center at INTEGRIS Baptist Medical Center in Oklahoma City. In addition, recurrence rates after an initial infection range from 15% to 25%, and the rate of recurrence after a recurrent infection ranges from 40% to 50%.

The fecal microbiota transplant (FMT) procedure has shown success in treating C. difficile, but long-term follow-up data are limited, Dr. Mellow said.

In this study, Dr. Mellow and his colleagues contacted patients who underwent colonoscopic FMT for recurrent C. difficile infections at least 3 months previously, via a mail or phone questionnaire. The patient population came from five different centers and included 56 women and 21 men. The patients ranged in age from 22 to 87 years, with a mean age of 65 years and an average illness duration of 11 months.

Pre-FMT data included health status, duration of infection, previous treatments, risk factors, and characteristics of the fecal donor. Post-FMT data included the effect of FMT on symptoms, time to improvement, and, in some cases, follow-up stool testing.

The average time to resolution of diarrhea after FMT was 6 days overall. Time to resolution was 3 days or less in 57 patients. Fatigue resolved in an average of 4 weeks overall, and in 1 week or less in 51 patients, Dr. Mellow said.

After an average of 17 months’ follow-up, 70 patients (91%) reported no recurrence of C. difficile.

"Despite lengthy illness before FMT, the response to FMT was rapid and sustained," and no patient developed a recurrent infection that did not receive subsequent antibiotic treatment for other infections, Dr. Mellow said.

Of the seven patients who failed an initial FMT treatment, four were successfully treated with a 2-week course of vancomycin alone or in combination with Florastor, Alinia, and kefir. Another two were treated successfully with a second FMT after failing a 2-week course of vancomycin, and one patient was not treated and died after spending time in hospice care.

The FMT procedure was well received in this patient population, most of whom had suffered with recurrent infection and failed multiple courses of standard treatments, Dr. Mellow noted. When patients were asked about their preferred treatment if their C. difficile infections were to recur, 53% said they would have a second FMT as their first choice for therapy, he said.

The findings were similar across all five centers, and support the effectiveness of FMT as a treatment option for patients with at least two prior bouts of C. difficile, Dr. Mellow said.

Dr. Mellow had no financial conflicts to disclose.

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