Abstract
Background
In recent years Faecal Microbiota Transplantation (FMT) is effectively implemented as an approved treatment approach of refractory Clostridiodes difficile infection (rCDI). In patients with inflammatory bowel disease (IBD) the prevalence of co-infection with CDI is higher than in the general population due to the use of immunosuppressive medication and dysbiosis of the bacteria in the colon. Just a small percentage of IBD patients do have an active CDI infection, not to be confused with carriership. Here we report the treatment course and efficacy of FMT provided by the Netherlands Donor Faeces Bank (NDFB) for IBD patients with rCDI.
Methods
The NDFB was founded to facilitate FMT by providing ready to use donor faeces suspensions for treatment of patients with rCDI in hospitals throughout The Netherlands. A request for FMT is evaluated by the working group (specialists in the fields of Medical Microbiology, Gastroenterology, and Infectious Diseases) to assess the indication of FMT and to formulate a treatment advice for each individual patient taking the comorbidity into account. Prior to FMT, all patients were pre-treated with vancomycin 250 mg for at least 4 days and bowel lavage. In patients with ulcerative colitis as comorbidity, prednisone was added when there was an IBD flare simultaneous. The results of FMT were monitored by prospective collection of outcome data by the NDFB.
Results
Since the start of NDFB in March 2016 until August 2019, 186 FMT requests to treat 176 (r)CDI patients were reviewed within the NDFB working group including 26 patients with rCDI and IBD. In total, 129 patients (of which 14 suffered from IBD) were treated with 143 FMTs for CDI with a cure rate of 89.9% after a single FMT (116/129). FMT was deemed not suitable in 12 of 26 patients with IBD because patients had C. Difficile carriership instead of an active CDI infection. Fourteen IBD patients were treated with FMT (9 ulcerative colitis, 2 Crohn’s disease and 2 indeterminate colitis). 3/14 patients suffered from rCDI with an active episode of IBD. Of the 14 IBD patients treated with FMT, only one patient developed a relapse of a CDI infection within 2-months (total cure rate 92%). This cure rate does not differ from CDI patients without IBD.
Conclusion
In IBD patients with rCDI, FMT is equally effective compared with other patients with rCDI. In case of concurrent activity of IBD, pre-treatment with prednisolone in combination with vancomycin appears to be effective.
Systematic review: faecal microbiota transplantation in the management of inflammatory bowel disease
