Safety of FMT Treatment for Recurrent C. Difficile Infection

Fecal microbiota transplantation (FMT) is highly effective for treating recurrent Clostridioides difficile infection (CDI). A prospective surveybased study was conducted from September 2012 to June 2018 in patients undergoing FMT for recurrent CDI.

Data on demographics and comorbidities were abstracted from medical records. Patients were contacted at 1 week, 1 month, 6 months, 1 year and greater than 2 years post-FMT (longterm). Symptoms and new medical diagnoses were recorded at each time point. Data was weighted to account for survey nonresponse bias. Multivariate logistic regression models for adverse events were built using age, sex, time of survey, and comorbidities.

Overall, 609 patients underwent FMT. Median age was 56 years (18-94), 64.8% were women, and 22.8% had IBD. At short-term followup (N = 609), greater than 60% of patients had diarrhea and 19 (33%) had constipation. At 1 year, 9.5% reported additional CDI episodes. On multivariable analysis, patients with IBD, dialysisdependent kidney disease and multiple FMTs had higher risk of diarrhea; risk of constipation was higher in women and lower in IBD. For long-term follow-up (N = 447), median time of follow-up was 3.7 years (2-6.8). Overall, 73 new diagnoses were reported; 13% gastrointestinal, 10% weight gain, 11.8% new infections deemed unrelated to FMT. Median time to infections was 29 months post-FMT.

It was concluded that FMT appears safe with low risk of transmission of infections. Several new diagnoses were reported that require exploration in future studies.

Saha, S., Mara, K., Pardi, D., and Khanna, S. “Long- Term Safety of Fecal Microbiota Transplantation for Recurrent Clostridioides Difficile Infection.” Gastroenterology 2021; Vol. 160, pp. 1961-1969.