Clostridium difficile infection (CDI) is a risk factor with increased morbidity and mortality in patients with inflammatory bowel disease (IBD). Fecal microbiota transplant (FMT) is a therapeutic option for recurrent CDI (rCDI) in patients with IBD, but a limited number of studies report increased risk of IBD flare following FMT for rCDI. As few studies have evaluated this trend to date, we aimed to compare the rates of IBD flare between IBD patients treated for rCDI with and without FMT.Methods:
We conducted a retrospective chart review of all IBD patients evaluated for rCDI between September 2013 and April 2016 at our institution, a tertiary care academic center. Recurrent CDI was defined as greater than or equal to 2 episodes of CDI. We compared IBD-related outcomes between patients treated for rCDI with FMT and patients treated for rCDI without FMT (non-FMT). Our primary outcome was the occurrence of an IBD flare requiring corticosteroid therapy within 30 days post-FMT for FMT patients or within 30 days following the most recent episode of rCDI for non-FMT patients. An important secondary outcome included the occurrence of an IBD flare requiring glucocorticoid treatment within 3 months post-FMT for FMT patients or within 3 months following the most recent episode of rCDI for non-FMT patients.Results:
Thirty-six patients with IBD were evaluated for rCDI. Seventeen patients underwent FMT, while 19 patients did not undergo FMT. The majority of patients (55%) were male, with a mean age of 45.9. The rates of IBD flare occurrence within 30 days following FMT or the last rCDI episode were 17.6% versus 36.8% for FMT and non-FMT patients, respectively (P = 0.274). Similarly, the rates of IBD flare occurrence within 3 months following FMT or most recent rCDI episode were 23.5% versus 47.3% for FMT and non-FMT patients, respectively (P = 0.137). Of note, FMT patients had an average of 4 historical episodes of CDI, while non-FMT patients had 3.3 episodes on average.Conclusions:
IBD patients treated for rCDI with and without FMT had similar rates of IBD flare within 30 days following FMT or most recent episode of rCDI, respectively. When examined with respect to the 3 months following FMT or most recent rCDI episode, FMT patients trended toward lower rates of flare of their underlying IBD than non-FMT patients. However, our study was underpowered and these differences could not achieve statistical significance. FMT may reduce the rate of IBD flare in the context of rCDI via resolution of recurrent CDI or restoration of a more normal fecal microbiome with improved host immune response and metabolic responses. Further studies with more patients are needed to determine the significance of these results.