title: Fecal Microbiota Transplantation for Recurrent Clostridium difficile Infection in the Elderly: Long-Term Outcomes and Microbiota Changes.
abstract: Fecal microbiota transplantation (FMT) has become the cornerstone in management of recurrent Clostridium difficile infection (RCDI) in adults. However, data on efficacy, safety, long-term outcomes, and microbiota alterations are limited in elderly patients (>65 years).
  
  
  
  Twenty-nine consecutive elderly patients with RCDI underwent FMT with combined jejunal and colonic method and monitored for long-term outcomes. Fecal samples from five elderly RCDI patients (G65) were subjected to genomic analysis before and after FMT, and microbiota changes were compared with matched RCDI patients below 65 years (L65).
  
  
  
  FMT resulted in marked improvement in all clinical parameters, including abdominal pain, bloating, and diarrhea in all elderly RCDI patients. Fecal C. difficile toxin was positive in all 29 patients and turned negative in all 27 patients, who agreed to undergo this test after FMT. Statistically significant improvement in leukocytosis was noted (p < 0.05). Only adverse events reported were transient mild fever (2/29) and bloating (3/29). Long-term follow-up over 25.4 ± 12.8 months did not reveal any additional adverse events or RCDI recurrence. Genomic analysis suggested that overall microbiota diversity increased post-FMT in elderly RCDI patients. However, this response was less robust than the younger group. While Firmicutes did not change markedly, Proteobacteria decreased significantly in post-FMT samples in elderly RCDI patients.
  
  
  
  These observations suggest that FMT in elderly patients with RCDI appears to be highly efficacious with no recurrence of infection over long-term follow-up. Alterations in microbiota in this group of patients are characterized by less robust increase in microbial diversity and marked reduction in phylum Proteobacteria.
authors.affiliation: Division of Gastroenterology, Department of Medicine, Johns Hopkins University/Sinai Hospital Program in Internal Medicine, Baltimore, MD, USA.|Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.
authors.forename: Mohit
authors.initials: M
authors.lastname: Girotra
authors.affiliation: Division of Gastroenterology, Department of Medicine, Johns Hopkins University/Sinai Hospital Program in Internal Medicine, Baltimore, MD, USA.|Division of Digestive Diseases and Nutrition, University of Kentucky, Lexington, KY, USA.
authors.forename: Shashank
authors.initials: S
authors.lastname: Garg
authors.affiliation: Division of Gastroenterology, Department of Medicine, Johns Hopkins University/Sinai Hospital Program in Internal Medicine, Baltimore, MD, USA.
authors.forename: Rohit
authors.initials: R
authors.lastname: Anand
authors.affiliation: Division of Gastroenterology, Department of Medicine, Johns Hopkins University/Sinai Hospital Program in Internal Medicine, Baltimore, MD, USA.|Institute of Genome Sciences, Baltimore, MD, USA.
authors.forename: Yang
authors.initials: Y
authors.lastname: Song
authors.affiliation: Division of Gastroenterology, Department of Medicine, Johns Hopkins University/Sinai Hospital Program in Internal Medicine, Baltimore, MD, USA. sdutta@lifebridgehealth.org.|University of Maryland School of Medicine, 2411 W. Belvedere Ave, Suite 305, Baltimore, MD, 21215, USA. sdutta@lifebridgehealth.org.
authors.forename: Sudhir K
authors.initials: SK
authors.lastname: Dutta
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001427:Bacterial Toxins / Q000235:genetics; D016360:Clostridioides difficile / Q000235:genetics; D004761:Enterocolitis, Pseudomembranous / Q000628:therapy*; D004768:Enterotoxins / Q000032:analysis; D004797:Enzyme-Linked Immunosorbent Assay; D000069467:Fecal Microbiota Transplantation; D005243:Feces / Q000737:chemistry / Q000382:microbiology; D005260:Female; D000068536:Bacillota / Q000235:genetics; D000069196:Gastrointestinal Microbiome / Q000235:genetics*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D011446:Prospective Studies; D020560:Proteobacteria / Q000235:genetics; D012336:RNA, Ribosomal, 16S / Q000235:genetics*; D012008:Recurrence; D017423:Sequence Analysis, RNA; D016896:Treatment Outcome
chemical_list: D001427:Bacterial Toxins; C488583:Clostridium difficile lethal toxin B; D004768:Enterotoxins; D012336:RNA, Ribosomal, 16S
keywords: Clostridium difficile; Colonic; Efficacy; Elderly; Fecal microbiota transplantation; Geriatric; Jejunal; Outcomes; Safety