Douglas K. Rex, MD reviewing Fischer M et al. Am J Gastroenterol 2016 Jul.

Disease severity, in-patient status, and additional C. difficile hospitalization were risk factors for failure.

Ten- to 20% of patients treated with fecal microbiota transplant (FMT) for recurrent or refractory Clostridium difficile infection (CDI) fail to experience a cure. Investigators sought to identify risk factors associated with such failure.

Data on 328 patients from two referral centers was used to determine predictors of FMT failure. Patients from a third center provided a validation cohort. Predictors of FMT failure were severe or severe-complicated disease, inpatient status at the time of FMT, and previous hospitalization for C. difficile.

A risk score of 0–13 indicated low, moderate, or high risk for early treatment failure. (Early failure was defined as nonresponse or recurrent diarrhea with positive C. difficile tests within 1 month of FMT.) Severe or severe-complicated disease contributed 5 points to the score and inpatient FMT 4 points, with 1 point for each CDI-related hospitalization. In the developmental cohort, the risk for early failure within the first month was 5.6% for low-risk, 12.7% for moderate -risk, and 41.0% for high-risk patients. Rates were similar in the validation cohort.

CITATION(S):

Fischer M et al. Predictors of early failure after fecal microbiota transplantation for the therapy of Clostridium difficile infection: A multicenter study. Am J Gastroenterol 2016 Jul; 111:1024. 

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