title: Predictors of failure after single faecal microbiota transplantation in patients with recurrent Clostridium difficile infection: results from a 3-year, single-centre cohort study.
abstract: OBJECTIVE
  Faecal microbiota transplantation (FMT) is an effective treatment for recurrent Clostridium difficile infection (CDI). Although a single faecal infusion is usually sufficient to eradicate CDI, a considerable number of patients need multiple infusions to be cured. The aim of this study was to identify predictors of failure after single faecal infusion in patients with recurrent CDI.
  
  
  METHODS
  We included patients with recurrent CDI prospectively treated with FMT by colonoscopy. By means of univariate and multivariate analysis, variables including female gender, age, number of CDI recurrences, severity of CDI, hospitalization, inadequate bowel preparation, unrelated donor, and use of frozen faeces, were assessed to predict failure after single faecal infusion.
  
  
  RESULTS
  Sixty-four patients (39 women; mean age 74 years) were included. Of them, 44 (69%) were cured by a single faecal infusion, whereas 20 (31%) needed repeat infusions. Overall, FMT cured 62 of 64 (97%) patients. In the subgroup of patients with severe CDI, only eight of 26 (30%) were cured with a single infusion. At multivariate analysis, severe CDI (OR 24.66; 95% CI 4.44-242.08; p 0.001) and inadequate bowel preparation (OR 11.53; 95% CI 1.71-115.51; p 0.019) were found to be independent predictors of failure after single faecal infusion.
  
  
  CONCLUSIONS
  Severe CDI and inadequate bowel preparation appear to be independent predictors of failure after single faecal infusion in patients treated with FMT by colonoscopy for recurrent CDI. Our results may help to optimize protocols and outcomes of FMT in patients with recurrent CDI.
authors.affiliation: Internal Medicine, Gastroenterology and Liver Unit, Gastroenterology Area, Fondazione Policlinico Universitario Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Ianiro
authors.affiliation: Department of Public Health, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: L
authors.initials: L
authors.lastname: Valerio
authors.affiliation: Institute of Microbiology, Fondazione Policlinico Universitario Gemelli, Università Cattolica del Sacro Cuore, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Masucci
authors.affiliation: Internal Medicine, Gastroenterology and Liver Unit, Gastroenterology Area, Fondazione Policlinico Universitario Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Pecere
authors.affiliation: Internal Medicine, Gastroenterology and Liver Unit, Gastroenterology Area, Fondazione Policlinico Universitario Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Bibbò
authors.affiliation: Institute of Microbiology, Fondazione Policlinico Universitario Gemelli, Università Cattolica del Sacro Cuore, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Quaranta
authors.affiliation: Institute of Public Health, Fondazione Policlinico Universitario Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: B
authors.initials: B
authors.lastname: Posteraro
authors.affiliation: Institute of Pharmacology, Fondazione Policlinico Universitario Gemelli, Università Cattolica del Sacro Cuore, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Currò
authors.affiliation: Institute of Microbiology, Fondazione Policlinico Universitario Gemelli, Università Cattolica del Sacro Cuore, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Sanguinetti
authors.affiliation: Internal Medicine, Gastroenterology and Liver Unit, Gastroenterology Area, Fondazione Policlinico Universitario Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Gasbarrini
authors.affiliation: Internal Medicine, Gastroenterology and Liver Unit, Gastroenterology Area, Fondazione Policlinico Universitario Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy. Electronic address: giovanni.cammarota@unicatt.it.
authors.forename: G
authors.initials: G
authors.lastname: Cammarota
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000628:therapy*; D015331:Cohort Studies; D003113:Colonoscopy; D000069467:Fecal Microbiota Transplantation; D005243:Feces / Q000382:microbiology; D005260:Female; D000069196:Gastrointestinal Microbiome; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D017211:Treatment Failure
keywords: Bowel preparation; Clostridium difficile infection; Colonoscopy; Faecal microbiota transplantation; Faecal transfer; Faecal transplant; Gastrointestinal infections; Microbiome; Microbiota