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P699 Faecal microbiota transplantation as treatment for recurrent clostridium difficile infections: a single-centre experience

C. Caenepeel*1, A. Schroë1, K. Van den Broeck2, M. Ferrante1,2, S. Vermeire1,2

1KU Leuven, TARGID, Leuven, Belgium, 2University hospitals Leuven, Gastroenterology and Hepatology, Leuven, Belgium

Background

Clostridium difficile infection (CDI) is a significant complicating factor in inflammatory bowel disease (IBD). IBD patients with CDI appear to flare worse than their non-IBD counterparts. Faecal microbiota transplantation (FMT) is recently recommended to effectively treat recurrent CDI (rCDI). Despite, FMT is still not a routine procedure in most centres. We describe our experience of FMT to treat rCDI in IBD patients and other indications, with focus on the identification of risk factors for FMT failure.

Methods

Patients were included retrospectively (2012–2018) if (I) CDI was confirmed in the faecal sample according to the ESCMID algorithm and (II) patients failed ≥2 antibiotics for CDI or had ≥2 laboratory-confirmed CDI recurrences. Demographic and clinical data were collected (Table 1).

Table 1. Overview of the demographic and clinical baseline characteristics

FMT success was defined as resolution of diarrhoea within 48 h, for ≥8 weeks. Statistical analyses were performed in JMP.

Results

We included 33 rCDI patients in which 8 IBD patients, 8 post-transplant patients and 1 multiple-sclerosis patient. Fifteen/33 patients were on immunosuppressive therapy during their first FMT. FMT success was seen in 24/33 patients (72.7%) after 1 FMT. This success ratio was not significantly different in IBD patients (Fisher exact test p = 0.37), post-transplant patients (p = 0.94), or for all immunocompromised patients combined (p = 0.741). Relapses were observed in 9/33 patients (27.3%) within 8 weeks and in 3/33 patients (9.1%) later on. Nine relapsed patients underwent a second FMT which was successful in 5 patients (4 received a different donor). The remaining 3 patients were successfully treated with a vancomycin based scheme. FMT was not efficacious in 7/33 patients. The overall cumulative success ratio was 78.8% with minimal side effects in 6/44 FMTs (13.6%). None of the demographic and clinical variables was significantly correlated with success after ≥1 FMTs. The use of a related donor tended to show a higher effectiveness after 1 FMT (p < 0.053). The presence of a predisposing infection treated with antibiotics gave a trend (p < 0.068) to a lower efficacy.

Conclusion

FMT is efficacious for rCDI, also in IBD and other immunocompromised patients. Our FMT success ratios and percentage of side effects are comparable to literature. Stratification of eligible patients for FMT can be useful. However, FMT failure was not associated with any risk factor or patient group. Donor faeces from a relative appears to increase FMT efficacy and multiple FMT treatment seemed to be less effective for patients with a predisposing infection.