Predictors of Fecal Microbiota Transplant Failure in Clostridioides difficile Infection : An Updated Meta-analysis.
Journal
Journal of clinical gastroenterology
ISSN: 1539-2031
Titre abrégé: J Clin Gastroenterol
Pays: United States
ID NLM: 7910017
Informations de publication
Date de publication:
01 04 2023
01 04 2023
Historique:
received:
13
08
2021
accepted:
08
12
2021
pubmed:
21
1
2022
medline:
11
3
2023
entrez:
20
1
2022
Statut:
epublish
Résumé
Fecal microbiota transplantation (FMT) is an effective treatment for recurrent/refractory Clostridioides difficile infection (CDI) with a 10% to 20% risk of recurrence after a single FMT. In this meta-analysis, we aimed to evaluate the predictors of FMT failure. A comprehensive search of MEDLINE, Embase, Cochrane, and Web of Science databases through July 2021 was performed. All studies that evaluated risk factors associated with FMT failure in a multivariate model were included. We calculated pooled odds ratios with 95% confidence intervals for risk factors reported in ≥3 studies using a random-effects model. Twenty studies involving 4327 patients (63.6% females) with recurrent/refractory CDI who underwent FMT were included. FMT failed in 705 patients (16.3%) with 2 to 3 months of follow-up in most studies. A total of 12 different risk factors were reported in a multivariate model in ≥3 studies. Meta-analysis showed that advanced age, severe CDI, inflammatory bowel disease, peri-FMT use of non-CDI antibiotics, prior CDI-related hospitalizations, inpatient status, and poor quality of bowel preparation were significant predictors of FMT failure. Charlson Comorbidity Index, female gender, immunosuppressed status, patient-directed donor, and number of CDI recurrences were not associated with FMT failure. Adequate bowel preparation at the time of FMT and optimizing antibiotic stewardship practices in the peri-FMT period can improve the success of FMT. Patients with nonmodifiable risk factors should be counseled about the risk of FMT failure. Our results may help develop a risk stratification model to predict FMT failure in CDI patients.
Identifiants
pubmed: 35050941
doi: 10.1097/MCG.0000000000001667
pii: 00004836-202304000-00008
doi:
Types de publication
Meta-Analysis
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
389-399Informations de copyright
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
Références
Meighani A, Hart BR, Bourgi K, et al. Outcomes of fecal microbiota transplantation for Clostridium difficile infection in patients with inflammatory bowel disease. Dig Dis Sci. 2017;62:2870–2875.
Surawicz CM, Alexander J. Treatment of refractory and recurrent Clostridium difficile infection. Nat Rev Gastroenterol Hepatol. 2011;8:330–339.
Kim P, Gadani A, Abdul-Baki H, et al. Fecal microbiota transplantation in recurrent Clostridium difficile infection: a retrospective single-center chart review. JGH Open. 2019;3:4–9.
Patron RL, Hartmann CA, Allen S, et al. Vancomycin taper and risk of failure of fecal microbiota transplantation in patients with recurrent Clostridium difficile infection. Clin Infect Dis. 2017;65:1214–1217.
Fischer M, Mehta S, Martin T, et al. Predictors of failure after fecal microbiota transplantation (FMT) for the therapy of Clostridium difficile infection (CDI). Am J Gastroenterol. 2015;110(suppl 1):S550–S595.
McDonald LC, Gerding DN, Johnson S, et al. Clinical Practice Guidelines for Clostridium difficile infection in adults and children: 2017 update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin Infect Dis. 2018;66:e1–e48.
Johnson S, Lavergne V, Skinner AM, et al. Clinical Practice Guideline by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA): 2021 focused update guidelines on management of Clostridioides difficile infection in adults. Clin Infect Dis. 2021;73:e1029–e1044.
Kelly CR, Fischer M, Allegretti JR, et al. ACG clinical guidelines: prevention, diagnosis, and treatment of Clostridioides difficile infections. Am J Gastroenterol. 2021;116:1124–1147.
Allegretti JR, Mehta SR, Kassam Z, et al. Risk factors that predict the failure of multiple fecal microbiota transplantations for Clostridioides difficile infection. Dig Dis Sci. 2021;66:213–217.
Khoruts A, Rank KM, Newman KM, et al. Inflammatory bowel disease affects the outcome of fecal microbiota transplantation for recurrent Clostridium difficile infection. Clin Gastroenterol Hepatol. 2016;14:1433–1438.
Fischer M, Kao D, Mehta SR, et al. Predictors of early failure after fecal microbiota transplantation for the therapy of Clostridium difficile infection: a multicenter study. Am J Gastroenterol. 2016;111:1024–1031.
Stull CE, Fritz B, Hardy J, et al. Mo1973—Predictors of treatment failure in fecal microbiota transplant for Clostridium difficile infection. Gastroenterology. 2019;156:S-907–S-908.
Tiwari A, Sharma H, Qamar K, et al. Sa1844—Factors predicting relapse of Clostridium difficile colitis following fecal microbiota transplantation (FMT). Gastroenterology. 2018;154:S-416–S-417.
Cheng YW, Phelps E, Ganapini V, et al. Fecal microbiota transplantation for the treatment of recurrent and severe Clostridium difficile infection in solid organ transplant recipients: a multicenter experience. Am J Transplant. 2019;19:501–511.
Peri R, Aguilar RC, Tuffers K, et al. The impact of technical and clinical factors on fecal microbiota transfer outcomes for the treatment of recurrent Clostridioides difficile infections in Germany. United Eur Gastroenterol J. 2019;7:716–722.
Meighani A, Hart BR, Mittal C, et al. Predictors of fecal transplant failure. Eur J Gastroenterol Hepatol. 2016;28:826–830.
Tirumanisetty P, Disalle M, Chodos A. Mo1980—Volume of fecal filtrate for fecal microbial transplantation does not affect the Clostridium difficile infection cure rate. Gastroenterology. 2019;156:S-910.
Tariq R, Hayat M, Pardi D, et al. Predictors of failure after fecal microbiota transplantation for recurrent Clostridioides difficile infection: a systematic review and meta-analysis. Eur J Clin Microbiol Infect Dis. 2021;40:1383–1392.
Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339:b2700.
Higgins JP, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ. 2003;327:557–560.
Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25:603–605.
Sterne JA, Egger M. Funnel plots for detecting bias in meta-analysis: guidelines on choice of axis. J Clin Epidemiol. 2001;54:1046–1055.
Egger M, Davey Smith G, Schneider M, et al. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315:629–634.
Duval S, Tweedie R. Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics. 2000;56:455–463.
Allegretti JR, Kao D, Sitko J, et al. Early antibiotic use after fecal microbiota transplantation increases risk of treatment failure. Clin Infect Dis. 2018;66:134–135.
Ianiro G, Valerio L, Masucci L, et al. Predictors of failure after single faecal microbiota transplantation in patients with recurrent Clostridium difficile infection: results from a 3-year, single-centre cohort study. Clin Microbiol Infect. 2017;23:337.e1–337.e3.
Kachlikova M, Sabaka P, Koscalova A, et al. Comorbid status and the faecal microbial transplantation failure in treatment of recurrent Clostridioides difficile infection—pilot prospective observational cohort study. BMC Infect Dis. 2020;20:52.
Stebel R, Vojtilova L, Svacinka R, et al. Faecal microbiota transplantation in the treatment of Clostridioides difficile infection. Hum Microbiome J. 2020;16:100070.
Watts AE, Richey M, Dougherty M, et al. Mo1943—Colonoscopy-based fecal microbiota transplantation is highly effective for Clostridioides infection, but severe disease predicts clinical failure. Gastroenterology. 2019;156:S-894.
Dimitry J, Keshteli A, Kao D. Independent predictors of failure of fecal microbiota transplantation (FMT) for recurrent or refractory Clostridium difficile infection. Can J Gastroenterol Hepatol. 2016;2016:72.
Tariq R, Saha S, Solanky D, et al. Predictors and management of failed fecal microbiota transplantation for recurrent Clostridioides difficile infection. J Clin Gastroenterol. 2021;55:542–547.
Mendelson AH, R S, Shay J, et al. Procedural-related and patient-related factors influence Clostridium difficile recurrence after fecal microbiota transplant. Gastroenterology. 2017;152:S949–S950.
Fischer M, Kelly CR, Phelps EL, et al. Quality of bowel preparation does not affect outcome of fecal microbiota transplantation for the therapy Clostridium difficile infection. Gastroenterology. 2017;152:S1004–S1005.
Jump RL. Clostridium difficile infection in older adults. Aging Health. 2013;9:403–414.
Cammarota G, Ianiro G, Tilg H, et al. European consensus conference on faecal microbiota transplantation in clinical practice. Gut. 2017;66:569–580.
Fischer M, Sipe BW, Rogers NA, et al. Faecal microbiota transplantation plus selected use of vancomycin for severe-complicated Clostridium difficile infection: description of a protocol with high success rate. Aliment Pharmacol Ther. 2015;42:470–476.
Fatima R, Aziz M. The hypervirulent strain of Clostridium difficile : NAP1/B1/027—a brief overview. Cureus. 2019;11:e3977.
Lee CH, Steiner T, Petrof EO, et al. Frozen vs fresh fecal microbiota transplantation and clinical resolution of diarrhea in patients with recurrent Clostridium difficile infection: a randomized clinical trial. JAMA. 2016;315:142–149.