Published online Dec 21, 2018. doi: 10.3748/wjg.v24.i47.5403
Peer-review started: August 10, 2018
First decision: October 24, 2018
Revised: November 26, 2018
Accepted: December 6, 2018
Article in press: December 6, 2018
Published online: December 21, 2018
Processing time: 133 Days and 18.3 Hours
To evaluate and describe the efficacy of fecal microbiota transplantation (FMT) for Clostridium difficile infection (CDI) in a national Israeli cohort.
All patients who received FMT for recurrent (recurrence within 8 wk of the previous treatment) or refractory CDI from 2013 through 2017 in all the five medical centers in Israel currently performing FMT were included. Stool donors were screened according to the Israeli Ministry of Health guidelines. Clinical and laboratory data of patients were collected from patients’ medical files, and they included indications for FMT, risk factors for CDI and disease severity. Primary outcome was FMT success (at least 2 mo free of CDI-related diarrhea post-FMT). Secondary outcomes included initial response to FMT (cessation of diarrhea within 7 d) and recurrence at 6 mo.
There were 111 FMTs for CDI, with a median age of 70 years [interquartile range (IQR): 53-82], and 42% (47) males. Fifty patients (45%) were treated via the lower gastrointestinal (LGI, represented only by colonoscopy) route, 37 (33%) via capsules, and 24 (22%) via the upper gastrointestinal (UGI) route. The overall success rate was 87.4% (97 patients), with no significant difference between routes of administration (P = 0.338). In the univariant analysis, FMT success correlated with milder disease (P = 0.01), ambulatory setting (P < 0.05) and lower Charlson comorbidity score (P < 0.05). In the multivariant analysis, only severe CDI [odd ratio (OR) = 0.14, P < 0.05] and inpatient FMT (OR = 0.19, P < 0.05) were each independently inversely related to FMT success. There were 35 (32%) patients younger than 60 years of age, and 14 (40%) of them had a background of inflammatory bowel disease.
FMT is a safe and effective treatment for CDI, with capsules emerging as a successful and well-tolerated route. Severe CDI is less likely to respond to FMT.
Core tip: Fecal microbiota transplantation (FMT) emerged as a promising treatment for Clostridium difficile infection (CDI). Our aim was to summarize the national Israeli experience in FMT. One-hundred and eleven patients with CDI underwent FMT, 37 (35%) of which via oral capsules and 50 (45%) via colonoscopy. The overall success rate was 87.4%, with no difference between administration routes. Success was independently related to mild disease and an ambulatory setting. One-third of the patients were younger than 60 years. 14 of which (40%) also suffered from inflammatory bowel disease. FMT is an effective treatment for recurrent CDI. FMT via capsules was shown to be a successful alternative to endoscopy.