Effectiveness of fecal microbiota transplantation in the treatment of patients with recurrent Clostridium difficile enterocolitis

Background and aim: The incidence rate of Cl. difficile enterocolitis is increasing. Antibiotic treatment of the Cl. difficile infection is frequently unsuccessful. Approximately 30% of patients emerge relapse after initial antibiotic therapy. In 10% of cases Cl. difficile bacteria is resistant to antibacterial medications. From 2015 the fecal microbiota transplantation is being used as a treatment option for patients with recurrent Cl. difficile infection in LUHS KC Department of Gastroenterology. The aim of this research is to analyze the effectiveness of fecal microbiota transplantation in patients with recurrent Cl. difficile infection and evaluate factors affecting the effectiveness of this procedure. Patients and methods: Retrospective analysis of patients (n=63) after treatment of recurrent CDI with fecal microbiota transplanataion in LUHS KC department of Gastroenterology was performed. To ascertain the effectiveness of FMT therapy patients were observed for eight weeks. SPSS 24.0 and MS Excel 2016 were used to perform statistical analysis of data. Kolmogorov-Smirnov, Mann-Whitney U and Chi-Square with degree of freedom (11s) tests were applied. The Binary logistic regression method was used to assess the dependence of binary variables on independent variables the odds ratio (OR) with its 95% confidence interval (CI) was estimated. Results: 275 cases of CDI were diagnosed in LUHS KC between 2012 and 2017. Most of the CDI cases were diagnosed in 2016 (n=87). FMT therapy received 50,8% (n=32) men and 49,2% (n=31) women. The mean age of patients who received FMT is 68,31 ±15,96 years. In most cases 73% (n=46) FMT was performed via nasojejunal tube. Capsulated FMT delivery was performed in 23,8% (n=15) cases and by enema in 3,2% (n=2) cases. Treatment after single FMT was successful in 79,4% (n=57) of cases. After second FMT treatment was successful in 90,5% of cases and after third FMT overall efficacy rate was 95,2% (n=60) of cases. There were not any severe complications for patients in our research. Patients who had used immunosuppressive medication had a lower chance of successful treatment after first FMT (OR 0,32; CI 95%; 0,31-32,44; p=0,045). Conclusions: Since 2012 to 2017 Incidence of Cl. difficile infection has increased in LUHS KC. FMT therapy is effective in treatment of patients with recurrent CDI. The likelihood of recovery after the first FMT procudure in patients receiving immunosuppressive medications is lower