Beneficial and Attributable Outcomes of Fecal Microbiota Transplantation in Recurrent Clostridioides difficile Patients Open Access

Stephenson, Meagan (Spring 2020)

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Current literature supports the use of fecal microbiota transplantation (FMT) as a successful treatment for recurrent Clostridioides difficile infection (CDI). A retrospective cohort study was performed to analyze clinical outcomes, including reinfection and death, associated with FMT treatment of recurrent C.difficile episodes. Data from the Georgia Emerging Infections Program (GAEIP) C.difficile population-based surveillance project was utilized to identify FMT-eligible incident episodes for analysis. Eligibility was defined as the second or more episode with no prior infection within the previous 8 weeks. Two cohorts were identified: an unexposed cohort of 1,118 non-FMT-treated eligible episodes, and an exposed cohort of 90 FMT-treated eligible episodes. Accounting for age at specimen collection as a confounder and for episode number and race as interaction terms, FMT was indicated to have a protective effect against re-infection. The relative risk of infection among FMT-treated episodes was 25% less than those non treated with FMT (RR=0.25, 95CI: 0.13, 0.48; p<0.0001). The episode 3 group experienced reduction of risk of the highest magnitude (RR=0.18, 95CI: 0.04, 0.74; p=0.0176). Stratified on race, it was determined that the most significantly protective effect of FMT was within the black category (RR=0.36, 95CI: 0.17, 0.78; p=0.0099). The 46-70 and 71-90+ age groups experienced lower risk of reinfection among FMT episodes (RR=0.15, 95CI: 0.07, 0.29; p<0.0001 and RR=0.17, 95CI: 0.07, 0.39; p<0.0001, respectively). Relative risk of death was found to be highly protective among episodes treated with FMT (RR=0.05, 95CI: 0.02, 0.10; p<0.0001). Risk of death among all three episode groups was significantly reduced among FMT-treated episodes. Relative risk of death among 18-45 year-olds treated with FMT was 0.03 times that of those not treated with FMT (95CI: 0.01, 0.11; p<0.0001). Survival analysis using the logrank statistic indicated a 10% (p=0.0305) difference between the cohorts. Those episodes treated with FMT were more likely to survive over the 7-year study period than those not treated with FMT. This analysis corroborates previous studies and suggests beneficial clinical outcomes associated with FMT as treatment for recurrent CDI.

Table of Contents


     I.        Introduction                                                                                                                        1

   II.        Methods                                                                                                                               4

a.    Study Design                                                                                                           4

b.    Study Population                                                                                                     4

c.    Study Outcomes                                                                                                      5

d.    Statistical Analysis                                                                                                  6

 III.        Results                                                                                                                                 7

a.    Cohort Demographics                                                                                          7

b.    Outcomes                                                                                                               8

 IV.        Discussion                                                                                                                         16

a.    Findings                                                                                                                16

b.    Limitations                                                                                                           17

c.    Conclusion                                                                                                            17

   V.        References                                                                                                                      19

*Disclaimer: The primary dataset used in this project was collected by the Georgia Emerging Infections Program (GAEIP). The GAEIP was not involved in the analyses presented in this thesis.

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