Outcomes of a Multidisciplinary Clinic in Evaluating Recurrent Clostridioides difficile Infection Patients for Fecal Microbiota Transplant: A Retrospective Cohort Analysis
Abstract
:1. Introduction
2. Methods
2.1. Study Setting
2.2. Study Design
2.3. Study Population
2.4. FMT Procedure
2.5. Patient Follow-Up
2.6. Study Outcomes
2.7. Statistical Analysis
3. Results
3.1. Cohort Demographics
3.2. Primary Outcomes
3.3. Secondary Outcomes
3.4. New Diagnoses Discovered from FMT Work-Up
4. Discussion
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Serum |
---|
Complete blood count |
Comprehensive metabolic panel |
Thyroid stimulating hormone |
Vitamin A, B12, D and zinc |
Immunoglobulin levels |
Erythrocyte sedimentation rate and c-reactive protein |
Serologies for human immunodeficiency virus, cytomegalovirus, Epstein-Barr virus, human T-cell lymphotropic virus, syphilis, and Strongyloides |
Tissue transglutaminase IgA |
Stool |
Campylobacter |
Cryptosporidium |
Giardia |
Norovirus |
Shiga toxin |
Clostridioides difficile toxin |
Culture |
Ova and parasite |
Lactoferrin |
Objectives |
---|
Clean the home with 10% bleach solution. |
Exchange toothbrush if kept within six feet of the toilet. |
Stop or decrease proton pump inhibitor if possible. |
Wash hands with soap and water. |
Use separate bathroom if there is more than one bathroom in the house. |
Avoid any unnecessary antibiotics. |
Variable | All Patients n = 113 | FMT n = 52 | Met Criteria but Not Treated with FMT n = 25 | Did not meet Criteria for FMT n = 36 | p Value |
---|---|---|---|---|---|
Age, mean (SD), y | 64 (18.5) | 67 (16.8) | 60 (21.1) | 62 (18.8) | 0.23 |
Female sex, N (%) | 80 (71) | 41 (79) | 16 (64) | 23 (64) | 0.22 |
Body mass index, mean | 26.12 | 27.04 | 25.79 | 25.02 | 0.29 |
Body mass index, SD | 5.99 | 6.42 | 5.82 | 5.41 | |
Mean number of C. difficile positive stools (SD) | 3 (1.50) | 3 (1.51) | 3 (1.33) | 2 (1.80) | 0.01 |
Hospitalized in past year, N (%) | 74 (66) | 35 (67) | 17 (68) | 22 (61) | 0.80 |
CDI related hospitalization, N (%) | 58 (51) | 27 (52) | 14 (56) | 17 (47) | 0.80 |
Diabetes mellitus, N (%) | 23 (20) | 10 (19) | 6 (24) | 7 (19) | 0.88 |
Hypertension, N (%) | 65 (58) | 30 (58) | 13 (52) | 22 (61) | 0.78 |
Hyperlipidemia, N (%) | 49 (43) | 26 (50) | 6 (24) | 17 (47) | 0.08 |
Gastrointestinal disorders, N (%) | 75 (66) | 33 (64) | 18 (72) | 24 (67) | 0.76 |
IBD, N (%) | 14 (12) | 6 (12) | 5 (20) | 3 (8) | 0.38 |
Ulcerative colitis, N | 6 | 2 | 2 | 2 (6) | |
Indeterminate colitis, N | 3 | 2 | 1 | 0 | |
Crohn’s disease, N | 4 | 2 | 2 | 0 | |
Possible IBD, N | 1 | 0 | 0 | 1 | |
Cardiac disorders, N (%) | 37 (33) | 14 (27) | 6 (24) | 17 (47) | 0.08 |
Malignancy, N (%) | 29 (26) | 15 (29) | 7 (28) | 7 (19) | 0.58 |
Pulmonary disorders, N (%) | 28 (25) | 7 (14) | 7 (28) | 14 (39) | 0.02 |
Thyroid disorders, N (%) | 25 (22) | 12 (23) | 3 (52) | 10 (28) | 0.34 |
Neurological disorders, N (%) | 25 (22) | 12 (23) | 7 (28) | 6 (17) | 0.56 |
Renal disorders, N (%) | 21 (19) | 11 (21) | 4 (16) | 6 (17) | 0.81 |
Immunosuppressive medications, N (%) | 27 (24) | 10 (19) | 9 (36) | 8 (22) | 0.26 |
Antibiotics (non-CDI), N (%) | 79 (70) | 38 (73) | 17 (68) | 24 (67) | 0.79 |
Acid suppressing agents, N (%) | 44 (39) | 20 (40) | 11 (44) | 13 (36) | 0.82 |
At skilled nursing facility, N (%) | 16 (14) | 9 (17) | 2 (8) | 5 (14) | 0.55 |
Reason for not doing FMT | Numbers |
---|---|
Resolved without FMT | 9 |
Did not follow up in clinic | 6 |
Patient preference | 5 |
Deferred due to risk from procedure due to leukopenia | 1 |
Deferred due to risk from procedure due to congestive heart failure | 1 |
Unable to complete colon prep | 1 |
Moved away | 1 |
Diarrhea attributed to other cause | 1 |
Gross Pathology (n =50) | n (%) |
---|---|
Normal | 11 (22) |
Abnormal | 39 (78) |
Diverticulosis | 22 (44) |
Gross Inflammation | 19 (38) |
Erythematous mucosa | 10 (20) |
Colitis | 5 (10) |
Ileal ulceration | 1 (2) |
Pseudomembranes | 1 (2) |
Mucosal congestion | 2 (4) |
Angiodysplasia | 2 (4) |
Neoplasm (new) | 5 (10) |
Polyp(s) | 4 (8) |
Mucosal edema | 1 (2) |
Microscopic Pathology (n = 35) | n (%) |
Normal | 19 (54) |
Abnormal | 16 (46) |
IBD | |
Colon: IBD | 7 |
Newly diagnosed IBD | 5 |
Ileum: Ulcers, IBD | 1 |
Microscopic colitis | |
Collagenous colitis | 2 |
Lymphocytic colitis | 2 |
Focal increase in intraepithelial lymphocytes | 1 |
Acute Inflammatory Process | |
Mildly active acute colitis | 1 |
Surface mucosal ulceration and epithelial regeneration | 1 |
Mild nonspecific reactive epithelial changes | 1 |
Neoplastic Process | |
Tubular or tubulovillous adenoma | 4 |
Moderately differentiated adenocarcinoma | 1 |
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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. https://doi.org/10.3390/jcm8071036
Shin JH, Chaplin AS, Hays RA, Kolling GL, Vance S, Guerrant RL, Archbald-Pannone L, Warren CA. Outcomes of a Multidisciplinary Clinic in Evaluating Recurrent Clostridioides difficile Infection Patients for Fecal Microbiota Transplant: A Retrospective Cohort Analysis. Journal of Clinical Medicine. 2019; 8(7):1036. https://doi.org/10.3390/jcm8071036
Chicago/Turabian StyleShin, Jae Hyun, Ashley S. Chaplin, R. Ann Hays, Glynis L. Kolling, Sheila Vance, Richard L. Guerrant, Laurie Archbald-Pannone, and Cirle A. Warren. 2019. "Outcomes of a Multidisciplinary Clinic in Evaluating Recurrent Clostridioides difficile Infection Patients for Fecal Microbiota Transplant: A Retrospective Cohort Analysis" Journal of Clinical Medicine 8, no. 7: 1036. https://doi.org/10.3390/jcm8071036