Background: Data is emerging on the efficacy of fecal microbial transplantation (FMT) for recurrent clostridium difficile infection (CDI) management with success rates of 80-90% in general population. Immunocompromised patients continue to be excluded from randomized trials involving FMT due to concerns related to its safety and efficacy. Current guidelines recommend caution with FMT in immunocompromised patients. Here we describe a series of five patients who were immunocompromised due to various reasons and received FMT for CDI.
Methods: Five immunocompromised patients who had FMT were followed for 8 weeks from the day of FMT to assess for adverse events and clinical cure. Clinical cure is defined as absence of >3 unformed stools during the 8 week follow up period. Treatment failure is defined as >3 unformed stools in 48 hour period, positive stool clostridium difficile toxin test, need for further medical or surgical management for CDI. Patient characteristics and the reasons for immunocompromised state are described in Table 1.
Results: Median age was 65 years. Patients had an average of 3.6 episodes of CDI and no hospitalizations secondary to CDI prior to index FMT. Four out of five patients (80%) who underwent large volume FMT through colonoscopy had clinical cure of their CDI (Table 1). One patient developed recurrent CDI in the 3rd week after FMT. No one developed any adverse events.
Conclusions: Our results emphasize that the efficacy of FMT in immunocompromised patients (80%) is comparable to general population. None of our patients experienced serious adverse events or reactivation of existing autoimmune diseases. It is important to extend the use of FMT in immunocompromised patients to better understand the efficacy and side effects in this subset of population. Our study adds to the growing literature supporting that fecal microbial transplantation appears to be safe and effective in certain immunocompromised patients.
