title: Fecal microbiota transplantation for recurrent Clostridium difficile infection in hematopoietic stem cell transplant recipients.
abstract: Recurrent Clostridium difficile infection (CDI) is a consequence of intestinal dysbiosis and is particularly common following hematopoietic stem cell transplantation (HSCT). Fecal microbiota transplantation (FMT) is an effective method of treating CDI by correcting intestinal dysbiosis by passive transfer of healthy donor microflora. FMT has not been widely used in immunocompromised patients, including HSCT recipients, owing to concern for donor-derived infection. Here, we describe initial results of an FMT program for CDI at a US HSCT center. Seven HSCT recipients underwent FMT between February 2015 and February 2016. Mean time post HSCT was 635 days (25-75 interquartile range [IQR] 38-791). Five of the patients (71.4%) were on immunosuppressive therapy at FMT; 4 had required long-term suppressive oral vancomycin therapy because of immediate recurrence after antibiotic cessation. Stool donors underwent comprehensive health and behavioral screening and laboratory testing of serum and stool for 32 potential pathogens. FMT was administered via the naso-jejunal route in 6 of the 7 patients. Mean follow-up was 265 days (IQR 51-288). Minor post-FMT adverse effects included self-limited bloating and urgency. One patient was suspected of having post-FMT small intestinal bacterial overgrowth. No serious adverse events were noted and all-cause mortality was 0%. Six of 7 (85.7%) patients had no recurrence; 1 patient recurred at day 156 post FMT after taking an oral antibiotic and required repeat FMT, after which no recurrence has occurred. Diarrhea was improved in all patients and 1 patient with gastrointestinal graft-versus-host disease was able to taper off systemic immunosuppression after FMT. With careful donor selection and laboratory screening, FMT appears to be a safe and effective therapy for CDI in HSCT patients and may confer additional benefits. Larger studies are necessary to confirm safety and efficacy and explore other possible effects.
authors.affiliation: Division of Epidemiology and Infectious Diseases, Intermountain Healthcare, Salt Lake City, Utah, USA.
authors.forename: B J
authors.initials: BJ
authors.lastname: Webb
authors.affiliation: Intermountain Acute Leukemia/Blood and Marrow Transplant Program, LDS Hospital, Salt Lake City, Utah, USA.
authors.forename: A
authors.initials: A
authors.lastname: Brunner
authors.affiliation: Intermountain Acute Leukemia/Blood and Marrow Transplant Program, LDS Hospital, Salt Lake City, Utah, USA.
authors.forename: C D
authors.initials: CD
authors.lastname: Ford
authors.affiliation: Division of Epidemiology and Infectious Diseases, Intermountain Healthcare, Salt Lake City, Utah, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Gazdik
authors.affiliation: Intermountain Acute Leukemia/Blood and Marrow Transplant Program, LDS Hospital, Salt Lake City, Utah, USA.
authors.forename: F B
authors.initials: FB
authors.lastname: Petersen
authors.affiliation: Intermountain Acute Leukemia/Blood and Marrow Transplant Program, LDS Hospital, Salt Lake City, Utah, USA.
authors.forename: D
authors.initials: D
authors.lastname: Hoda
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000382:microbiology / Q000628:therapy*; D003967:Diarrhea / Q000382:microbiology / Q000628:therapy*; D064806:Dysbiosis / Q000150:complications / Q000628:therapy*; D000069467:Fecal Microbiota Transplantation / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D005243:Feces / Q000737:chemistry / Q000382:microbiology; D005260:Female; D000069196:Gastrointestinal Microbiome / Q000276:immunology; D006086:Graft vs Host Disease / Q000188:drug therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D016867:Immunocompromised Host / Q000276:immunology; D007165:Immunosuppression Therapy / Q000009:adverse effects* / Q000379:methods; D007422:Intestines / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: Clostridium difficile infection; fecal microbiota transplantation; graft-versus-host disease; hematopoietic stem cell transplantation; microbiome