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• W2977307364 abstract "Introduction:Clostridium difficile infection (CDI) is a leading cause of healthcare-associated infections with a mortality rate of >10%. Total abdominal colectomy (TAC) has been the standard treatment for severe and complicated CDI, but is associated with high mortality rates of 25% to 80%. Loop ileostomy with colonic lavage (IL) and fecal microbiota transplantation (FMT) are two suggested alternative therapies with limited data. Currently, there are no publications comparing the three treatment modalities. The aim of this study is to compare the outcomes of FMT, a less invasive modality, to those of IL and TAC in severe and complicated CDI. Methods: A retrospective single-institution study was conducted of all hospitalized patients with severe and complicated CDI who received FMT, IL, or TAC between April 2011 and July 2015. Preprocedure and post-procedure data were collected. Patients without pseudomembranous colitis were excluded. Results: Six patients underwent FMT, ten patients underwent IL, and thirteen patients underwent TAC. All groups had similar demographics and degree of critical illness, although the median WBC prior to procedure was higher in surgical groups (39.3 k/μL in IL, 28.7 k/μL in TAC) than in FMT group (7.71 k/μL). No FMT patients had post-intervention complications compared to 60% of IL patients (p=0.034) and 85% of TAC patients (p=0.001). Post-intervention, FMT required no ventilator or ICU days compared to a median of 3.5 ventilator days and 6 ICU days for IL (p=0.002, p=0.002) and 3 ventilator days and 8 ICU days for TAC (p=0.003, p=0.001). The in-hospital mortality rates for FMT, IL, and TAC were 17%, 30%, and 23%, and 1-year mortality rates were 33%, 40%, and 46%, respectively. No deaths in the FMT group were associated with FMT/CDI, whereas 3 IL (30%) and 4 TAC (41%) deaths were associated with surgery/CDI. The 30-day readmission rate for FMT, IL, and TAC were 20%, 57%, and 40%.Table 1: Characteristics of FMT Patients Compared to IL and TAC Patients with Severe and Complicated CDIConclusion: Compared to IL and TAC in our limited series, FMT had fewer post-intervention complications, ventilator days, and ICU days. FMT had similar, if not lower, mortality rates and re-admission rates compared to IL and TAC. We propose that FMT is a reasonable treatment option for patients with severe and complicated CDI before they develop toxic megacolon and require surgical therapy. Further studies with larger sample sizes are needed for validation and to determine optimal timing of FMT in this setting.Table 2: FMT Outcomes Compared to IL and TAC Outcomes in Severe and Complicated CDI" @default.
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• W2977307364 date "2016-10-01" @default.
• W2977307364 modified "2023-09-27" @default.
• W2977307364 title "Comparing Fecal Microbiota Transplantation to Total Abdominal Colectomy and Loop Ileostomy in Severe and Complicated Clostridium difficile Infections" @default.
• W2977307364 doi "https://doi.org/10.14309/00000434-201610001-00198" @default.
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