2006. Long-term efficacy of lower-gastrointestinal delivery fecal microbiota transplantation for recurrent Clostridioides difficile infection


 
 
 The rate of recurrent Clostridioides difficile infection (rCDI) is 15-28% for those that initially respond to antibiotics and increases to about 50% in those with more than two recurrences. Fecal microbiota transplantation (FMT) is a treatment option for patients that have failed antibiotics for at least two rCDIs or for those with severe or fulminant CDI refractory to antibiotics. Data assessing the long-term efficacy of FMT beyond 1 year are scarce. The objective of this study is to evaluate the long-term efficacy of lower-gastrointestinal (GI) delivery FMT in addition to standard of care pharmacotherapy (SOCp) for rCDI compared to patients that received SOCp alone.
 
 
 
 This is a single center, retrospective cohort study that included patients 18-99 years old who received either SOCp or FMT in addition to SOCp for rCDI between January 1, 2018 and December 30, 2020. Exclusion criteria were pregnancy or receipt of upper-GI delivery FMT. The primary endpoint was rCDI within 12 months. Secondary endpoints were all-cause mortality at 6, 12, 18, and 24 months, recurrence at 6, 18, and 24 months, and time to first recurrence of CDI (months). Patients were propensity matched based on age, immunocompromised status, and antibiotic received for index rCDI episode.
 
 
 
 The rCDI rate at 12 months was 8% and 50% in the FMT (n = 24) and SOCp (n = 24) groups, respectively (p = 0.0001). The rCDI rate at 24 months was 8.3% and 50% in the FMT and SOCp groups, respectively (p=0.0015). Mean time to 1st rCDI episode was 15.5 and 1.5 months in the FMT and SOCp groups, respectively (p = 0.0255). All-cause mortality at 24 months was 17% and 21% in the FMT and SOCp groups, respectively (p = 0.81).
 
 
 
 Patients who received FMT in addition to SOCp had a significantly lower rate of recurrence and a significantly longer time to subsequent recurrence compared with the SOCp group. There was no significant difference in all-cause mortality between the groups.
 
 
 
 All Authors: No reported disclosures.
