FMT Lowers Risk of Bloodstream Infection in Recurrent Clostridioides difficile Infection

Patients with recurrent Clostridioides difficile infection (CDI) who receive treatment with fecal microbiota transplantation (FMT) are less likely to develop primary bloodstream infection, according to new study findings.

While FMT is more effective than antibiotics in the treatment of patients with recurrent CDI, its efficacy in the prevention of CDI-related bloodstream infection is uncertain.

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To study this, the researchers analyzed data of 290 patients with CDI who received treatment with either FMT (n=109) or antibiotics (n=181). Patients in the FMT group and patients in the antibiotics group were matched on propensity score.

Because of the differences in many baseline characteristics among the patients who received treatment with FMT vs patients who received antibiotics, comparative analyses were limited to the matched cohort (57 patients per treatment).

The primary outcome was primary bloodstream infection within 90 days. Secondary outcomes included length of hospitalization and overall survival (OS) at 90 days.

Results indicated that 5 patients in the FMT group and 40 patients in the antibiotic group developed bloodstream infection.

The risk of bloodstream infection was 23 percentage points lower among patients in the FMT group. Additionally, patients in the FMT group had 14 fewer days of hospitalization and a 32-percentage point increase in OS compared with patients in the antibiotic group.

“In a propensity score–matched cohort, patients with recurrent CDI treated with FMT were less likely to develop primary [bloodstream infection],” the researchers concluded.

—Melinda Stevens

Reference:

Ianiro G, Murri R, Sciumè GD, et al. Incidence of bloodstream infections, length of hospital stay, and survival in patients with recurrent Clostridioides difficile infection treated with fecal microbiota transplantation or antibiotics: a prospective cohort study [published online November 5, 2019]. Ann Intern Med. doi:10.7326/M18-3635.