In addition to fewer days of hospitalization and a reduced risk for overall mortality within 90 days, patients with recurrent Clostridioides difficile infection (CDI) were less likely to develop bloodstream infections (BSI) if treated with fecal microbiota transplantation (FMT) compared with antibiotics, according to research results published in the Annals of Internal Medicine.

In this single-center prospective cohort study conducted at a tertiary care center in Rome, Italy, researchers examined the incidence of primary BSI within 90 days in 290 patients with recurrent CDI treated with FMT vs antibiotics. Secondary outcomes were length of hospitalization and overall survival at 90 days.

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Of the 290 patients, 109 were treated with FMT and 181 received antibiotic therapy. A higher percentage of patients had sustained cure of CDI after treatment in the FMT group than in the antibiotic group (97% vs 38%). Overall, 45 patients developed a BSI during the 90-day follow-up (5 from the FMT group vs 40 from the antibiotic group). Mean length of hospitalization was shorter in patients treated with FMT vs antibiotics (13.3 days vs 29.7 days). Overall survival at 90 days for the whole cohort was 73%, with 100 patients (92%) surviving in the FMT group and 111 (61%) in the antibiotic group.

To create a more valid and counterfactual comparison group, researchers used a propensity score matching to match comparison and intervention participants. The matched-cohort analysis included 57 of 109 patients treated with FMT and 57 of 109 patients treated with antibiotics. Compared with the antibiotics group, the FMT group had a 23% lower risk for BSI (95% CI, 10%-35%), 14 fewer days of hospitalization (95% CI, 9-20 days), and a 32% increase in overall survival (95% CI, 16%-47%).

While researchers used the propensity score matching to reduce differences between the groups, an imbalance in several baseline characteristics persisted, limiting the generalizability of the findings. Patients in the FMT group were younger, had a lower Charlson Comorbidity Index score, a higher percentage had a mild clinical picture of CDI, a lower percentage had only 1 CDI recurrence, and a higher percentage had central venous catheter at enrollment.

In addition, researchers did not collect stool samples from patients before and after the treatments to assess shifts in gut microbiota composition, nor did they assess the cost-effectiveness of using FMT in recurrent CDI.

Thus, “future studies that use a randomized controlled design, microbial analysis, and collection of economic data are needed,” noted the study authors. If larger, randomized studies confirm findings from this study, “FMT could be considered an effective treatment option to both cure [recurrent] CDI and prevent some of its complications, including BSI,” concluded the researchers.

Disclosure: Maurizio Sanguinetti, MD, reports grants from Recordati, Pfizer, and Menarini outside the submitted work.

Reference

Ianiro G, Murri R, Sciumè GD, et al. Incidence of bloodstream infections, length of hospital stay, and survival in patients with recurrent Clostridioides difficile infection treated with fecal microbiota transplantation or antibiotics: a prospective cohort study [published online November 5, 2019]. Ann Intern Med. doi:10.7326/M18-3635