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Outcomes of a Multidisciplinary Clinic in Evaluating Recurrent Clostridioides difficile Infection Patients for Fecal Microbiota Transplant: A Retrospective Cohort Analysis

1
Department of Medicine, Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA 22903, USA
2
Novant Health, Winston-Salem, NC 27103, USA
3
Department of Medicine, Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, VA 22903, USA
4
Department of Gastroenterology, Veterans Affairs Connecticut Healthcare System, West Haven, CT 06516, USA
5
Department of Medicine, Division of General, Geriatric, Palliative and Hospital Medicine, University of Virginia, Charlottesville, VA 22093, USA
*
Author to whom correspondence should be addressed.
These two authors contribute equally to this work.
J. Clin. Med. 2019, 8(7), 1036; https://doi.org/10.3390/jcm8071036
Received: 3 June 2019 / Revised: 18 June 2019 / Accepted: 9 July 2019 / Published: 16 July 2019
(This article belongs to the Section Microbiology & Parasitology)
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PDF [677 KB, uploaded 16 July 2019]
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Abstract

Fecal microbiota transplantation (FMT) has been shown to be an effective treatment for recurrent Clostridioides difficile infections (rCDIs). We assessed the benefits of a multidisciplinary C. difficile clinic for screening FMT eligibility in patients with rCDI. Patients seen at the University of Virginia Complicated C. difficile Clinic (CCDC) underwent comprehensive evaluation for possible FMT. Patients were eligible for FMT if there was history of greater than two episodes of rCDI. Patients were evaluated for the outcome after evaluation in the clinic. A total of 113 patients were evaluated: 77 were eligible for FMT, of which 25 patients did not undergo FMT. The rate of recurrence at three months and all-cause mortality were 4.5% and 7% for patients who received FMT and 16.7% and 12.5% for eligible patients who did not receive FMT. There were 36 patients who were not eligible for FMT, with two or fewer recurrences and a recurrence rate of 8.8% and all-cause mortality of 6%. One in three patients screened for FMT had a nutritional deficiency diagnosed, with zinc deficiency being most common (20%). Additional diagnoses, including inflammatory bowel disease, were made during the evaluation. FMT is a highly effective treatment for rCDI, most notably in patients with multiple recurrences. A systematic approach for evaluating patients with rCDI helps identify patients who benefit most from FMT and those who have other conditions. View Full-Text
Keywords: Clostridium difficile infection; Clostridioides difficile infection; fecal microbiota transplant; recurrent C. difficile Clostridium difficile infection; Clostridioides difficile infection; fecal microbiota transplant; recurrent C. difficile
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Shin, J.H.; Chaplin, A.S.; Hays, R.A.; Kolling, G.L.; Vance, S.; Guerrant, R.L.; Archbald-Pannone, L.; Warren, C.A. Outcomes of a Multidisciplinary Clinic in Evaluating Recurrent Clostridioides difficile Infection Patients for Fecal Microbiota Transplant: A Retrospective Cohort Analysis. J. Clin. Med. 2019, 8, 1036.

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