Durability and Long-Term Clinical Outcomes of Fecal Microbiota Transplant (FMT) Treatment in Patients with Recurrent Clostridium difficile Infection

Abstract

Background

Fecal microbiota transplant (FMT) appears safe and effective for treatment of recurrent Clostridium difficile infection (RCDI). However, durability, long-term clinical outcomes of FMT for RCDI, and patient satisfaction after FMT are not well described.

Methods

Eligible patients who received FMT for RCDI at Emory Hospital between July 1, 2012 and December 31, 2016 were contacted via telephone for a follow up survey. Of 190 eligible patients, 137 (72%) patients completed the survey.

Results

Median time from last FMT to follow up was 22 months. Overall, 82% (113/137) of patients at follow up had no recurrence of C. difficile infection (CDI) post-FMT (non-RCDI group) and 18% (24/137) of patients had CDI post-FMT (RCDI group). Antibiotic exposure for non-CDI infections after FMT was more common in the RCDI group compared to the non-RCDI group, 75% vs 38%, p=0.0009, respectively. Overall, 11% of patients reported improvement or resolution of diagnoses not related to CDI post-FMT and 33% reported development of a new medical condition or symptom post-FMT. Ninety-five percent of patients (122/128) indicated that they would undergo FMT again, and 70% of these 122 reported that they would prefer FMT to antibiotics as initial treatment if they were to have a CDI recurrence.

Conclusions

In this follow up survey of outcomes after FMT at median 22 months' follow-up, 82% of patients had durable cure of CDI. Patients with recurrence had more post-FMT antibiotic exposure, underscoring the need for thoughtful antibiotic use and a potential role for prophylactic microbiome enrichment to reduce recurrence.