Kelly I. Suchman, MD1, Yuying Luo, MD1, Ari M. Grinspan, MD2; 1Icahn School of Medicine at Mount Sinai, New York, NY; 2Mount Sinai Hospital, New York, NY
Introduction: Immunocompromised patients are particularly vulnerable to Clostridioides difficile infection (CDI), CDI-related hospitalizations and CDI recurrence. Studies have shown fecal microbiota transplant (FMT) to be both safe and effective in immunocompromised patients. We aimed to examine the outcomes of FMT for CDI in a diverse cohort of immunocompromised patients stratified by medication class. Methods: We performed a retrospective, long-term follow-up study of immunocompromised patients who received a FMT. Patients included those with malignancy undergoing chemotherapy, neutropenia, HIV positive, inflammatory bowel disease patients on biologic or other immunomodulatory therapy, history of solid organ transplant on immunosuppression or patients on prednisone or its equivalent of >20 mg/day. Outcome measures included primary cure and recurrence rates, adverse events, and subgroup analysis of outcomes by immunosuppressive medication class. Results: Our cohort included 77 immunosuppressed patients (53.2% female) with an average age of 42.5 ± 22.0 years. The majority of our cohort were IBD patients on immunosuppressive medications (53, 68.8%), 10 (13.0%) with organ transplants, 7 (9.1%) undergoing chemotherapy, and 5 (8.3%) HIV positive. 16 patients (20.8%) developed recurrent CDI, including 13 early (< 12 weeks following FMT) and 3 late ( >12 weeks). Adjusting for colectomies and deaths, our cure rate was 82.0%. There was no difference in recurrence by medication classes. Twelve patients received FMT for severe or fulminant CDI with a 3-month survival rate of 91.7%. 11.7% of our cohort experienced serious adverse events following FMT including three IBD flares, four admissions for recurrent CDI, one admission for abdominal pain and vomiting and one death in a liver transplant patient who transitioned to hospice in the setting of fulminant CDI. Discussion: Our study describes a large cohort of 77 immunocompromised patients who received FMT for recurrent, severe or fulminant CDI. We found an adjusted cure rate of 82.0%, with a low serious adverse event rate of 11.7%, including 1 death. The majority of serious adverse events occurred in patients with severe and fulminant CDI; however, the 3 month survival of this population was 91.7%. There was no difference in recurrence rate based on immunosuppressive class. Further controlled studies are essential to ascertain the safety and efficacy of FMT in the immunosuppressed population.
Table 1: Patient Characteristics
Table 2: Medication Class, Immunocompromised Status and CDI Recurrences
Table 3. Severe and Fulminant Cases by Immunosuppressive Medication Class
Disclosures: Kelly Suchman indicated no relevant financial relationships. Yuying Luo indicated no relevant financial relationships. Ari Grinspan indicated no relevant financial relationships.