TY - JOUR
T1 - The impact of technical and clinical factors on fecal microbiota transfer outcomes for the treatment of recurrent Clostridioides difficile infections in Germany
AU - for the German Clinical Microbiome Study Group (GCMSG)
AU - Peri, Rosemarie
AU - Aguilar, Rebeca Cruz
AU - Tüffers, Kester
AU - Erhardt, Andreas
AU - Link, Alexander
AU - Ehlermann, Philipp
AU - Angeli, Wolfgang
AU - Frank, Thorsten
AU - Storr, Martin
AU - Glück, Thomas
AU - Sturm, Andreas
AU - Rosien, Ulrich
AU - Tacke, Frank
AU - Bachmann, Oliver
AU - Solbach, Philipp
AU - Stallmach, Andreas
AU - Goeser, Felix
AU - Vehreschild, Maria J.G.T.
N1 - Publisher Copyright:
© Author(s) 2019.
PY - 2019/6/1
Y1 - 2019/6/1
N2 - Introduction: Fecal microbiota transfer (FMT) is highly effective in the treatment and prevention of recurrent Clostridioides difficile infection (rCDI) with cure rates of about 80% after a single treatment. Nevertheless, the reasons for failure in the remaining 20% remain largely elusive. The aim of the present study was to investigate different potential clinical predictors of response to FMT in Germany. Methods: Information was extracted from the MicroTrans Registry (NCT02681068), a retrospective observational multicenter study, collecting data from patients undergoing FMT for recurrent or refractory CDI in Germany. We performed binary logistic regression with the following covariates: age, gender, ribotype 027, Eastern Co-operative Oncology Group score, immunosuppression, preparation for FMT by use of proton pump inhibitor, antimotility agents and bowel lavage, previous recurrences, severity of CDI, antibiotic induction treatment, fresh or frozen FMT preparation, and route of application. Results: Treatment response was achieved in 191/240 evaluable cases (79.6%) at day 30 (D30) post FMT and 78.1% at day 90 (D90) post FMT. Assessment of clinical predictors for FMT failure by forward and confirmatory backward-stepwise regression analysis yielded higher age as an independent predictor of FMT failure (p = 0.001; OR 1.060; 95%CI 1.025–1.097). Conclusion: FMT in Germany is associated with high cure rates at D30 and D90. No specific pre-treatment, preparation or application strategy had an impact on FMT success. Only higher age was identified as an independent risk factor for treatment failure. Based on these and external findings, future studies should focus on the assessment of microbiota and microbiota-associated metabolites as factors determining FMT success.
AB - Introduction: Fecal microbiota transfer (FMT) is highly effective in the treatment and prevention of recurrent Clostridioides difficile infection (rCDI) with cure rates of about 80% after a single treatment. Nevertheless, the reasons for failure in the remaining 20% remain largely elusive. The aim of the present study was to investigate different potential clinical predictors of response to FMT in Germany. Methods: Information was extracted from the MicroTrans Registry (NCT02681068), a retrospective observational multicenter study, collecting data from patients undergoing FMT for recurrent or refractory CDI in Germany. We performed binary logistic regression with the following covariates: age, gender, ribotype 027, Eastern Co-operative Oncology Group score, immunosuppression, preparation for FMT by use of proton pump inhibitor, antimotility agents and bowel lavage, previous recurrences, severity of CDI, antibiotic induction treatment, fresh or frozen FMT preparation, and route of application. Results: Treatment response was achieved in 191/240 evaluable cases (79.6%) at day 30 (D30) post FMT and 78.1% at day 90 (D90) post FMT. Assessment of clinical predictors for FMT failure by forward and confirmatory backward-stepwise regression analysis yielded higher age as an independent predictor of FMT failure (p = 0.001; OR 1.060; 95%CI 1.025–1.097). Conclusion: FMT in Germany is associated with high cure rates at D30 and D90. No specific pre-treatment, preparation or application strategy had an impact on FMT success. Only higher age was identified as an independent risk factor for treatment failure. Based on these and external findings, future studies should focus on the assessment of microbiota and microbiota-associated metabolites as factors determining FMT success.
KW - Fecal microbiota transfer
KW - microbiota
KW - recurrent Clostridioides difficile infection
KW - risk factors
UR - http://www.scopus.com/inward/record.url?scp=85063353769&partnerID=8YFLogxK
U2 - 10.1177/2050640619839918
DO - 10.1177/2050640619839918
M3 - Article
C2 - 31210950
AN - SCOPUS:85063353769
SN - 2050-6406
VL - 7
SP - 716
EP - 722
JO - United European Gastroenterology Journal
JF - United European Gastroenterology Journal
IS - 5
ER -