Faecal transplant benefit holds firm despite CDI risk factor exposure

Faecal microbiota transplantation (FMT) response may be sustained even after being exposed to Clostridioides difficile infection (CDI) risk factors, such as comorbidities and use of systemic antibiotics or acid suppressant medications, among others, a study reports. Antibiotic use post-FMT is predictive of response loss.

The study included 460 patients (median age, 57 years; 65.2 percent female) who had undergone FMT for recurrent CDI (98.5 percent received FMT from a standard donor).

A total of 374 patients were exposed to one or more risk factors for CDI up to 1-year post-FMT. Comorbidities included chronic liver disease (12.8 percent), cancer (11.7 percent), chronic kidney disease (3.9 percent), and inflammatory bowel disease (21.9 percent). Meanwhile, 31.3 percent of the patients received antibiotics, 21.7 percent received acid suppressants, and 76.8 percent had healthcare exposure after FMT.

Only six patients (1.3 percent) did not respond to FMT. Among the nonexposed cohort, two patients developed CDI episode within 8 weeks of treatment, and another two did after 8 weeks. This corresponded to an FMT failure rate of 5 percent.

In the exposed cohort, 78.1 percent of patients showed durable response to FMT at 12 months; 21.9 percent had a CDI episode within 1 year of treatment. Such episodes occurred in 23.3 percent of patients who received antibiotics. The median time to the first CDI episode was 119 days post-FMT.

On multivariable Cox analysis, antibiotic use emerged as a significant predictor of decreased durability of FMT (hazard ratio, 0.27, 95 percent confidence interval, 0.15–0.49; p<0.001).

More studies are required to define factors associated with durable FMT response in patients with and without antibiotic exposure.