title: Fecal Microbiota Transplantation is Safe and Efficacious for Recurrent or Refractory Clostridium difficile Infection in Patients with Inflammatory Bowel Disease.
abstract: New treatments are needed as Clostridium difficile infection (CDI) is becoming increasingly formidable. Fecal microbiota transplantation (FMT) has a 90% success rate in the treatment of recurrent CDI. However, evidence regarding its safety, efficacy, and effect on disease activity in patients with inflammatory bowel disease (IBD) is lacking.
  
  
  
  This cohort study used data from 8 national and international academic centers. Patients with established IBD who underwent FMT for recurrent CDI were followed for a minimum of 3 months. The primary outcome was CDI recurrence at 3 months after FMT. The secondary outcomes were (1) IBD activity and severity at 3 months based on the judgment of the treating physician, endoscopic findings, and clinical disease activity scores; and (2) safety.
  
  
  
  Sixty-seven patients were included in the analysis. Thirty-five (52%) had Crohn's disease, 31 (46%) ulcerative colitis, and one indeterminate colitis with 43 (64%) patients on an immunosuppressive agent at the time of FMT. The initial FMT was successful in 53 (79%) patients. After the FMT, IBD disease activity was reported as improved in 25 (37%), no change in 20 (30%), and worse in 9 (13%) patients. Serious adverse events included colectomy (1.4%), hospitalization for CDI (2.9%), hospitalization for IBD flare (2.9%), small bowel obstruction (1.4%), CMV colitis (1.4%), and pancreatitis (1.4%).
  
  
  
  The overall CDI cure rates were high, with a large percentage of patients experiencing clinical improvement of their IBD after FMT. A minority of patients developed an IBD flare. No severe adverse events directly attributable to FMT were found in this largest reported series of recurrent or refractory CDI patients with concurrent IBD.
authors: *Indiana University, Indianapolis, Indiana; †University of Alberta, Edmonton, Alberta, Canada; ‡Lifespan Women's Medicine Collaborative and the Alpert Medical School of Brown University, Providence, Rhode Island; §Henry Ford Hospital, Detroit, Michigan; ‖Integris Digestive Health Center, Oklahoma City, Oklahoma; ¶Hospital Saint-Antoine, Paris, France; **Brigham and Women's Hospital, Boston Massachusetts; and ††Community Hospital, Anderson, Indiana.
authors: Monika
authors: M
authors: Fischer
authors: Dina
authors: D
authors: Kao
authors: Colleen
authors: C
authors: Kelly
authors: Aishwarya
authors: A
authors: Kuchipudi
authors: Syed-Mohammed
authors: SM
authors: Jafri
authors: Mark
authors: M
authors: Blumenkehl
authors: Douglas
authors: D
authors: Rex
authors: Mark
authors: M
authors: Mellow
authors: Nirmal
authors: N
authors: Kaur
authors: Harry
authors: H
authors: Sokol
authors: Gwen
authors: G
authors: Cook
authors: Matthew J
authors: MJ
authors: Hamilton
authors: Emmalee
authors: E
authors: Phelps
authors: Brian
authors: B
authors: Sipe
authors: Huiping
authors: H
authors: Xu
authors: Jessica R
authors: JR
authors: Allegretti
mesh_terms: D000328:Adult; D016360:Clostridioides difficile; D004761:Enterocolitis, Pseudomembranous / Q000382:microbiology / Q000628:therapy*; D000069467:Fecal Microbiota Transplantation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome