scholarly journals A Mathematical Model to Evaluate the Routine Use of Fecal Microbiota Transplantation to Prevent Incident and Recurrent Clostridium difficile Infection

2014 ◽  
Vol 35 (1) ◽  
pp. 18-27 ◽  
Author(s):  
Eric T. Lofgren ◽  
Rebekah W. Moehring ◽  
Deverick J. Anderson ◽  
David J. Weber ◽  
Nina H. Fefferman
Keyword(s):  
Mathematical Model ◽  
High Risk ◽  
Clostridium Difficile ◽  
Fecal Microbiota Transplantation ◽  
Fecal Microbiota ◽  
Low Risk ◽  
Billing Data ◽  
Potential Health ◽  
Significant Difference ◽  
Incident Cases

Objective.Fecal microbiota transplantation (FMT) has been suggested as a new treatment to manage Clostridium difficile infection (CDI). With use of a mathematical model of C. difficile within an intensive care unit (ICU), we examined the potential impact of routine FMT.Design, Setting, and Patients.A mathematical model of C. difficile transmission, supplemented with prospective cohort, surveillance, and billing data from hospitals in the southeastern United States.Methods.Cohort, surveillance, and billing data as well as data from the literature were used to construct a compartmental model of CDI within an ICU. Patients were defined as being in 1 of 6 potential health states: uncolonized and at low risk; uncolonized and at high risk; colonized and at low risk; colonized and at high risk; having CDI; or treated with FMT.Results.The use of FMT to treat patients after CDI was associated with a statistically significant reduction in recurrence but not with a reduction in incident cases. Treatment after administration of high-risk medications, such as antibiotics, did not result in a decrease in recurrence but did result in a statistically significant difference in incident cases across treatment groups, although whether this difference was clinically relevant was questionable.Conclusions.Our study is a novel mathematical model that examines the effect of FMT on the prevention of recurrent and incident CDI. The routine use of FMT represents a promising approach to reduce complex recurrent cases, but a reduction in CDI incidence will require the use of other methods to prevent transmission.

scholarly journals Applying fecal microbiota transplantation (FMT) to treat recurrent Clostridium difficile infections (rCDI) in children

PeerJ ◽  
2018 ◽  
Vol 6 ◽  
pp. e4663 ◽  
Author(s):  
Shaaz Fareed ◽  
Neha Sarode ◽  
Frank J. Stewart ◽  
Aneeq Malik ◽  
Elham Laghaie ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Adverse Effects ◽  
Gut Microbiome ◽  
Pediatric Patients ◽  
Fecal Microbiota Transplantation ◽  
Diversity Index ◽  
Microbial Community Composition ◽  
Fecal Microbiota ◽  
Rrna Gene ◽  
Significant Difference

Background Fecal Microbiota Transplantation (FMT) is an innovative means of treating recurrent Clostridium difficile infection (rCDI), through restoration of gut floral balance. However, there is a lack of data concerning the efficacy of FMT and its impact on the gut microbiome among pediatric patients. This study analyzes clinical outcomes and microbial community composition among 15 pediatric patients treated for rCDI via FMT. Methods This is a prospective, observational, pilot study of 15 children ≤18 years, who presented for rCDI and who met inclusion criteria for FMT at a pediatric hospital and pediatric gastroenterology clinic. Past medical history and demographics were recorded at enrollment and subsequent follow-up. Specimens of the donors’ and the patients’ pre-FMT and post-FMT fecal specimen were collected and used to assess microbiome composition via 16S rRNA gene sequencing. Results FMT successfully prevented rCDI episodes for minimum of 3 months post-FMT in all patients, with no major adverse effects. Three patients reported continued GI bleeding; however, all three also had underlying Inflammatory Bowel Disease (IBD). Our analyses confirm a significant difference between pre-and post-FMT gut microbiome profiles (Shannon diversity index), whereas no significant difference was observed between post-FMT and donor microbiome profiles. At the phyla level, post-FMT profiles showed significantly increased levels of Bacteroidetes and significantly decreased levels of Proteobacteria. Subjects with underlying IBD showed no difference in their pre-and post-FMT profiles. Conclusion The low rate of recurrence or re-infection by C. difficile, coupled with minimal adverse effects post-FMT, suggests that FMT is a viable therapeutic means to treat pediatric rCDI. Post-FMT microbiomes are different from pre-FMT microbiomes, and similar to those of healthy donors, suggesting successful establishment of a healthier microbiome.

scholarly journals 1497. Relapsing Clostridium difficile Infection: Resolution with Combined Patient Choice Fecal Microbiota Transplantation, Vancomycin Taper, and Vancomycin Suppression

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S545-S545
Author(s):  
Rebecca D Shadowen ◽  
Steven A Edds
Keyword(s):  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Complete Resolution ◽  
Fecal Microbiota Transplantation ◽  
The United States ◽  
Fecal Microbiota ◽  
Small Sample ◽  
Patient Choice ◽  
Primary Study ◽  
Significant Difference

Abstract Background Clostridium difficile infection (CDI) results in approximately a half a million cases and 15,000 deaths annually in the United States. Relapse rates vary between 20 and 50% and account for frequent readmissions and morbidity. Application of treatment modalities for relapsing cases resulting in complete resolution is reported here. Methods An observational analytical cohort study was done from June 2014 to December 2018 by offering options to patients for treatment of their CDI relapse. Each chose between Fecal Microbiota Transplantation (FMT; N = 52), Vancomycin po 6-week taper (VTa; N = 4), or Vancomycin 125 mg po daily 6-month suppression (VSu; N = 18). The FMT was given either as a liquid NG instillation (FMT-L) twice 12–24 hours apart (N = 47) or 20 capsules (FMT-C) given over 90 minutes (N = 5). Patients were followed for at least 8 weeks after treatment with readmissions tracked for 6 months in all cases. Fisher exact test was used for statistical significance. Results No patient was readmitted to the hospital for CDI-associated problems during the term of this study. More men choose po Vancomycin with more women choosing FMT (VTa/VSu Female 38%: Male 62% and FMT Female 80%: Male 20%; P < 0.01). Overall, initial response rate was 90%. Resolution of CDI was highest among the FMT-L (95.7%; N = 45/47; P = 1) and the VSu (94%; N-17/18; P = 1). The VTa group had 75% resolution (N = 3/4; nsd). The FMT-C arm showed a 40% success rate (N = 2/5; nsd). Treatment failures (N = 7) chose re-treatment with 6 cases repeating VTa having one relapse responding to FMT-L. One relapse in the VSu group responded to a 6 months daily Vancomycin suppressive course. The only statistically significant difference was in male to female ratios. Cost of therapy was highest for FMT-L $2326, FMT-C $1870, VSu $965, and VTa $700 average per course. Conclusion This report integrates options in treatment that follows the relapsing CDI patient to complete resolution. This eliminated hospital readmission and further morbidity. Allowing the patient freedom of treatment option was well received. Of the treatment arms, FMT-L and VSu were equivalent in outcomes, followed by VTa and FMT-C. FMT-L as 2 instillations provides higher response rates than previously reported. This was a small sample size; however, primary study endpoints of no hospitalizations and complete resolution were attained. Disclosures All authors: No reported disclosures.

scholarly journals Patient Perspectives on Fecal Microbiota Transplantation for Clostridium Difficile Infection

2016 ◽  
Vol 5 (2) ◽  
pp. 155-164 ◽  
Author(s):  
Caroline Zellmer ◽  
Travis J. De Wolfe ◽  
Sarah Van Hoof ◽  
Rebekah Blakney ◽  
Nasia Safdar
Keyword(s):  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Fecal Microbiota Transplantation ◽  
Fecal Microbiota ◽  
Patient Perspectives

scholarly journals Complete Microbiota Engraftment Is Not Essential for Recovery from Recurrent Clostridium difficile Infection following Fecal Microbiota Transplantation

mBio ◽  
2016 ◽  
Vol 7 (6) ◽  
Author(s):  
Christopher Staley ◽  
Colleen R. Kelly ◽  
Lawrence J. Brandt ◽  
Alexander Khoruts ◽  
Michael J. Sadowsky
Keyword(s):  
Clostridium Difficile ◽  
Bacterial Communities ◽  
Healthy Donor ◽  
Fecal Microbiota Transplantation ◽  
Fecal Microbiota ◽  
Mean Value ◽  
Bile Acid Metabolism ◽  
Secondary Bile Acid ◽  
Stool Samples ◽  
Relative Abundances

ABSTRACT Bacterial communities from subjects treated for recurrent Clostridium difficile infection (rCDI) by fecal microbiota transplantation (FMT), using either heterologous donor stool samples or autologous stool samples, were characterized by Illumina next-generation sequencing. As previously reported, the success of heterologous FMT (90%) was superior to that of autologous FMT (43%) ( P = 0.019), and post-FMT intestinal bacterial communities differed significantly between treatment arms ( P < 0.001). Subjects cured by autologous FMT typically had greater abundances of the Clostridium XIVa clade and Holdemania bacteria prior to treatment, and the relative abundances of these groups increased significantly after FMT compared to heterologous FMT and pre-FMT samples. The typical shift to post-FMT, donor-like assemblages, featuring high relative abundances of genera within the Bacteroidetes and Firmicutes phyla, was not observed in the autologous FMT subjects. Autologous FMT patient bacterial communities were significantly different in composition than those for heterologous FMT patients and donors ( P < 0.001). The SourceTracker program, which employs a Bayesian algorithm to determine source contributions to sink communities, showed that patients initially treated by heterologous FMT had significantly higher percentages of engraftment (i.e., similarity to donor communities, mean value of 74%) compared to those who suffered recurrence following autologous FMT (1%) ( P ≤ 0.013). The findings of this study suggest that complete donor engraftment may be not necessary if functionally critical taxa are present in subjects following antibiotic therapy. IMPORTANCE This study provides a detailed characterization of fecal bacterial communities in subjects who participated in a previously published randomized clinical trial to treat recurrent C. difficile infection (rCDI). Bacterial communities were characterized to determine differences between subjects who received fecal bacteria either from healthy donor stool samples or their own stool samples as “placebo” in order to determine which groups of bacteria were most important in achieving a cure. The results of this study suggested that bacteria associated with secondary bile acid metabolism could potentially provide resistance to infection and that complete transfer of healthy donor microorganisms was not necessary to resolve CDI following unsuccessful antibiotic treatment.

Sign in / Sign up

Export Citation Format

Share Document