Recurrent Clostrioides difficile Infection and Fecal Microbiota Transplantation in the Atlanta Metropolitan Area: 2016-2019 Open Access
Mehta, Nirja (Spring 2022)
Abstract
Patients with multiple recurrences of Clostridioides difficile infection (CDI) have longer hospital stays and lower quality of life. Understanding characteristics of patients with multiple recurrent CDI episodes is important as these patients may benefit from microbiota restoring therapies in addition to standard antibiotics therapy to prevent further CDI recurrence.
Rates of recurrent Clostridioides difficile infection and the use of fecal microbiota transplantation (FMT) were studied in the metropolitan Atlanta area between 2016 to 2019 using three community wide databases: the Georgia Emerging Infections Program, the Georgia Hospital Association Discharge Database and the Atlanta Fecal Microbiota Transplantation. These databases were used to determine the number and chronology of recurrent CDI, associated demographic and comorbid conditions with patients with CDI and contextualize CDI and FMTs with regard to hospital admissions.
Among13,852 patients with at least one episode of CDI, 3,038 (22%) had at least one recurrence within 365 days. Patients with co-morbid conditions (i.e., pulmonary disease, renal disease, liver disease and diabetes) and those hospitalized for any reason soon after a CDI episode were more likely to have a recurrence. In this cohort, 250 FMTs were administered. Of patients with three or more episodes of CDI, 12% of patients received a FMT. FMTs were administered disproportionately to white, young women. Patient with co-morbid conditions such as cerebrovascular disease, congestive heart failure, diabetes, renal disease and liver disease were less likely to have received an FMT. FMT receipt was associated with decreased CDI recurrence (OR: 0.6; CI: 0.37-0.95) in a multivariable logistic regression model with propensity matching for likelihood of FMT receipt, compared to antibiotics alone in patients with recurrent CDI.
Table of Contents
Table of Contents
Introduction
Background
Methods
Results
Discussion
Conclusions
References
Figures and tables
Figure 1: Flow Diagram of CDI patients and Linkage to External Datasets
Figure 3: Annual Incidence of Recurrent CDI per 100,000 population in the Atlanta Metropolitan Area between 2016-2019 by Age Group
Figure 4: Clostridioides difficile Diagnostic Methodology by Year
Figure 5: Days between Sequential Fecal microbiota transplant (FMT ) Administration in Patients with Multiple FMTs, 2016-2019, by Sequence
Figure 6: Standardize mean differences between cases in controls in the Propensity Matched Cohort compared to all observations
Table 1: Definitions and datasets of origin
Table 2: Demographic and Baseline Characteristics of CDI patients, by recurrence category: Patient level Data
Table 4: Demographic characteristics of Patients with CDI, by FMT receipt status: Patient level evaluation
Table 5: Patient’s Sequential CDI Episode Number Immediately Prior to FMT Administration among CDI Patients with at least one Recurrent CDI and at least one Hospitalization: Episode Level Dataset
Table 6: Frequency of Episodes at Each Recurrence of CDI (Recurrence Number) among CDI Patients with at least one Recurrent CDI and at least one Hospitalization: Episode level dataset.
Table 7: Demographic and Clinical Characteristics Associated with Episodes of CDI that had recurrence within 365 days: Episode Level dataset
Table 8: Predictors for Receipt of FMT among CDI episodes among patients with at least one recurrence and hospitalization: Episode Level Data
Table 9: Baseline Characteristics in Propensity Score-Matched Controls and Cases, matched on likelihood for CDI episodes receiving FMT: Propensity Matched Cohort
Table 10: Univariate and Multivariate analysis Predicting Recurrence of CDI: Propensity Matched Cohort
About this Master's Thesis
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