title: Fecal microbiota transplant for treatment of Clostridium difficile infection in immunocompromised patients.
abstract: OBJECTIVE
  Patients who are immunocompromised (IC) are at increased risk of Clostridium difficile infection (CDI), which has increased to epidemic proportions over the past decade. Fecal microbiota transplantation (FMT) appears effective for the treatment of CDI, although there is concern that IC patients may be at increased risk of having adverse events (AEs) related to FMT. This study describes the multicenter experience of FMT in IC patients.
  
  
  METHODS
  A multicenter retrospective series was performed on the use of FMT in IC patients with CDI that was recurrent, refractory, or severe. We aimed to describe rates of CDI cure after FMT as well as AEs experienced by IC patients after FMT. A 32-item questionnaire soliciting demographic and pre- and post-FMT data was completed for 99 patients at 16 centers, of whom 80 were eligible for inclusion. Outcomes included (i) rates of CDI cure after FMT, (ii) serious adverse events (SAEs) such as death or hospitalization within 12 weeks of FMT, (iii) infection within 12 weeks of FMT, and (iv) AEs (related and unrelated) to FMT.
  
  
  RESULTS
  Cases included adult (75) and pediatric (5) patients treated with FMT for recurrent (55%), refractory (11%), and severe and/or overlap of recurrent/refractory and severe CDI (34%). In all, 79% were outpatients at the time of FMT. The mean follow-up period between FMT and data collection was 11 months (range 3-46 months). Reasons for IC included: HIV/AIDS (3), solid organ transplant (19), oncologic condition (7), immunosuppressive therapy for inflammatory bowel disease (IBD; 36), and other medical conditions/medications (15). The CDI cure rate after a single FMT was 78%, with 62 patients suffering no recurrence at least 12 weeks post FMT. Twelve patients underwent repeat FMT, of whom eight had no further CDI. Thus, the overall cure rate was 89%. Twelve (15%) had any SAE within 12 weeks post FMT, of which 10 were hospitalizations. Two deaths occurred within 12 weeks of FMT, one of which was the result of aspiration during sedation for FMT administered via colonoscopy; the other was unrelated to FMT. None suffered infections definitely related to FMT, but two patients developed unrelated infections and five had self-limited diarrheal illness in which no causal organism was identified. One patient had a superficial mucosal tear caused by the colonoscopy performed for the FMT, and three patients reported mild, self-limited abdominal discomfort post FMT. Five (14% of IBD patients) experienced disease flare post FMT. Three ulcerative colitis (UC) patients underwent colectomy related to course of UC >100 days after FMT.
  
  
  CONCLUSIONS
  This series demonstrates the effective use of FMT for CDI in IC patients with few SAEs or related AEs. Importantly, there were no related infectious complications in these high-risk patients.
authors.affiliation: Division of Gastroenterology, Brown Alpert Medical School, Women's Medicine Collaborative, Alpert Medical School of Brown University, Providence, Rhode Island, USA.
authors.forename: Colleen R
authors.initials: CR
authors.lastname: Kelly
authors.affiliation: Division of Gastroenterology, Brown Alpert Medical School, Women's Medicine Collaborative, Alpert Medical School of Brown University, Providence, Rhode Island, USA.
authors.forename: Chioma
authors.initials: C
authors.lastname: Ihunnah
authors.affiliation: Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: Monika
authors.initials: M
authors.lastname: Fischer
authors.affiliation: University of Minnesota Medical School, Minneapolis, Minnesota, USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Khoruts
authors.affiliation: University of Washington School of Medicine, Seattle, Washington, USA.
authors.forename: Christina
authors.initials: C
authors.lastname: Surawicz
authors.affiliation: University of Washington School of Medicine, Seattle, Washington, USA.
authors.forename: Anita
authors.initials: A
authors.lastname: Afzali
authors.affiliation: Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.
authors.forename: Olga
authors.initials: O
authors.lastname: Aroniadis
authors.affiliation: Lahey Clinic Hospital and Medical Center, Tufts University School of Medicine, Burlington, Massachusetts, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Barto
authors.affiliation: Centre for Digestive Diseases, Five Dock, Sydney, New South Wales, Australia.
authors.forename: Thomas
authors.initials: T
authors.lastname: Borody
authors.affiliation: Northern California Gastroenterology Consultants, Inc., Oakland, California, USA.
authors.forename: Andrea
authors.initials: A
authors.lastname: Giovanelli
authors.affiliation: California Pacific Medical Center, San Francisco, California, USA.
authors.forename: Shelley
authors.initials: S
authors.lastname: Gordon
authors.affiliation: Virginia Mason Medical Center, Seattle, Washington, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Gluck
authors.affiliation: Massachusetts General Hospital and Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: Hohmann
authors.affiliation: University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Dina
authors.initials: D
authors.lastname: Kao
authors.affiliation: University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: John Y
authors.initials: JY
authors.lastname: Kao
authors.affiliation: Lahey Clinic Hospital and Medical Center, Tufts University School of Medicine, Burlington, Massachusetts, USA.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: McQuillen
authors.affiliation: Integris Baptist Medical Center, Oklahoma, Oklahoma, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Mellow
authors.affiliation: University of Minnesota Medical School, Minneapolis, Minnesota, USA.
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Rank
authors.affiliation: University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Krishna
authors.initials: K
authors.lastname: Rao
authors.affiliation: Ochsner Clinic Foundation, New Orleans, Louisiana, USA.
authors.forename: Arnab
authors.initials: A
authors.lastname: Ray
authors.affiliation: Virginia Mason Medical Center, Seattle, Washington, USA.
authors.forename: Margot A
authors.initials: MA
authors.lastname: Schwartz
authors.affiliation: Seattle Children's Hospital, Seattle, Washington, USA.
authors.forename: Namita
authors.initials: N
authors.lastname: Singh
authors.affiliation: Northern California Gastroenterology Consultants, Inc., Oakland, California, USA.
authors.forename: Neil
authors.initials: N
authors.lastname: Stollman
authors.affiliation: Seattle Children's Hospital, Seattle, Washington, USA.
authors.forename: David L
authors.initials: DL
authors.lastname: Suskind
authors.affiliation: University of Washington School of Medicine, Seattle, Washington, USA.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Vindigni
authors.affiliation: Massachusetts General Hospital and Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Ilan
authors.initials: I
authors.lastname: Youngster
authors.affiliation: Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Brandt
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D016360:Clostridioides difficile; D004761:Enterocolitis, Pseudomembranous / Q000382:microbiology* / Q000628:therapy*; D005243:Feces / Q000382:microbiology*; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D064307:Microbiota; D008875:Middle Aged; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome