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The Long-term Efficacy and Safety of Fecal Microbiota Transplant for Recurrent, Severe, and Complicated Clostridium difficile Infection in 146 Elderly Individuals
Abstract
OBJECTIVES: Clostridium difficile infection (CDI) in the elderly has a higher prevalence, greater morbidity and mortality, and lower response to conventional treatment than the general population. Fecal microbiota transplant (FMT) is highly effective therapy for CDI but has not been studied specifically in the elderly. This study aims to determine the long-term efficacy and safety of FMT for recurrent (RCDI), severe (SCDI), and complicated (CCDI) CDI in elderly patients. METHODS: A multicenter, long-term follow-up study was performed with demographic, pre-FMT, and post-FMT data collected from elderly patients with RCDI, SCDI, and CCDI, through a 47-item questionnaire. Outcome measures included primary and secondary cure rates, early (<12 wk) and late (≥12 wk) recurrence rates, and adverse events (AEs), including post-FMT diagnoses. RESULTS: Of 168 eligible patients, 146 patients met the inclusion criteria. Of these, 68.5% were women. The mean (range) age was 78.6 (65 to 97) years and the follow-up period was 12.3 (1 to 48) months. FMT was performed for RCDI in 89 (61%), SCDI in 45 (30.8%), and CCDI in 12 (8.2%) patients. The primary and secondary cure rates were 82.9% and 95.9%, respectively. Early and late recurrences occurred in 25 and 6 patients, respectively. AEs included CDI-negative diarrhea in 7 (4.8%) and constipation in 4 (2.7%) patients. Serious AEs, recorded in 6 patients, were hospital admissions for CDI-related diarrhea, one of which culminated in death. New diagnoses post-FMT included microscopic colitis (2), Sjogren syndrome (1), follicular lymphoma (1), contact dermatitis and idiopathic Bence-Jones proteinuria (1), and laryngeal carcinoma (1)-all, however, were associated with predisposing factors. CONCLUSIONS: FMT is a safe and effective treatment option for RCDI, SCDI, and CCDI in elderly patients.
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“Regarding C. difficile infection, the best methodology to reduce the associated diarrhea and to eradicate this pathogen is the fecal microbiota transplantation, which has shown up to 95.9% success, including recalcitrant and severe cases (114).”
From Bifidobacteria and Their Health-Promoting Effects (2017) · cites this paper as [114]
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Popa, D., Neamtu, B. M., Mihalache, M., Boicean, A., Banciu, A., Banciu, D. D., Moga, D. F. C., & Bîrluțiu, V. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10245822 · Cited by 27
Diet-microbiome-gut-brain nexus in acute and chronic brain injury
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Tixier, E. N., Verheyen, E., Luo, Y., Grinspan, L. T., Du, C., Ungaro, R. C., Walsh, S., & Grinspan, A. M. (2021) · Digestive Diseases and Sciences · doi:10.1007/s10620-021-06908-4 · Cited by 27
Kim, P., Gadani, A., Abdul‐Baki, H., Mitre, R., & Mitre, M. (2019) · JGH Open · doi:10.1002/jgh3.12093 · Cited by 24
Infection, inflammation and hepatic encephalopathy from a clinical perspective
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Clostridium difficile Infection
Shin, J. H., Chaves‐Olarte, E., & Warren, C. A. (2016) · Microbiology Spectrum · doi:10.1128/microbiolspec.ei10-0007-2015 · Cited by 22
Microscopic colitis—microbiome, barrier function and associated diseases
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Current and future trends in clostridioides (clostridium) difficile infection management
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The Present Status of Fecal Microbiota Transplantation and Its Value in the Elderly
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Frontiers in antibiotic alternatives for Clostridioides difficile infection
Phanchana, M., Harnvoravongchai, P., Wongkuna, S., Phetruen, T., Phothichaisri, W., Panturat, S., Pipatthana, M., Charoensutthivarakul, S., Chankhamhaengdecha, S., & Janvilisri, T. (2021) · World Journal of Gastroenterology · doi:10.3748/wjg.v27.i42.7210 · Cited by 23
Voth, E. R., & Khanna, S. (2020) · Expert Review of Anti-infective Therapy · doi:10.1080/14787210.2020.1752192 · Cited by 19
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Self-citationRegulatory functions and mechanisms of human microbiota in infectious diseases
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Mini-Review: Human Microbiome and Rheumatic Diseases
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Metadata
- Authors
- Agrawal, M., Aroniadis, O. C., Brandt, L. J., Kelly, C., Freeman, S., Surawicz, C., Broussard, E., Stollman, N., Giovanelli, A., Smith, B., Yen, E., Trivedi, A., Hubble, L., Kao, D., Borody, T., Finlayson, S., Ray, A., & Smith, R.
- Affiliations
- Montefiore Medical Center (US)
- ORCID
- Venue
- Journal of Clinical Gastroenterology
- Published
- 2016-05
- Volume
- 50
- Issue
- 5
- Pages
- 403-407
- ISSN
- 0192-0790 (ISSN-L)
- OpenAlex
- W2176600848
- Cited by
- 186
- References
- 30
- Citations by year
- 2026: 5 · 2025: 4 · 2024: 11 · 2023: 14 · 2022: 15 · 2021: 24 · 2020: 25 · 2019: 18 · 2018: 25 · 2017: 24 · 2016: 17
- FWCI
- 17.93
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Clinical Gastroenterology (publishedVersion)
- PubMed (publishedVersion)
- OPUS - Open Publications of UTS Scholars (University of Technology Sydney) (submittedVersion)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Clostridium difficile and Clostridium perfringens research
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Keywords
- fecal microbiota transplantation, Clostridium difficile infection, recurrent Clostridium difficile infection, severe CDI, elderly patients, long-term efficacy, safety, recurrence, adverse events, microscopic colitis, Sjögren's syndrome, follicular lymphoma, constipation
- MeSH terms
- Fecal Microbiota Transplantation, Age Factors, Aged, Aged, 80 and over, Clostridium Infections, Female, Humans, Male, Surveys and Questionnaires, Recurrence, Retrospective Studies, Severity of Illness Index, Time Factors, Clostridioides difficile, Treatment Outcome
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