Colon to Rectum

Clin Gastroenterol Hepatol. 2022;20(4):806–16.e6

Dawwas GK, Brensinger CM, Vajravelu RK, Wu Q, Kelly CR, Laine L, Wu GD, Lewis JD

Long-term outcomes following multiply recurrent Clostridioides difficile infection and fecal microbiota transplantation

Background and aims: Fecal microbiota transplantation (FMT) is a commonly used therapy for multiply recurrent Clostridioides difficile infection (mrCDI). By altering the gut microbiota, there is the potential for FMT to impact the risk for cardiometabolic, intestinal or immune-mediated conditions. Likewise, the microbiota disturbance associated with mrCDI could potentially lead to these conditions. The authors aimed to assess the associations of mrCDI and FMT with cardiometabolic, immune-mediated diseases, and irritable bowel syndrome (IBS).
Methods: This retrospective cohort study using a United States commercial claims database included persons diagnosed with CDI or undergoing FMT. The authors created 2 pairwise comparisons: mrCDI versus non-mrCDI, and non-mrCDI or mrCDI treated with FMT versus mrCDI without FMT.
Results: No significant association was found between mrCDI (vs. non-mrCDI) and inflammatory bowel disease (adjusted hazard ratio [aHR] = 1.65; 95% confidence interval [CI]: 0.67–4.04), rheumatoid arthritis (HR = 0.86; 95% CI: 0.47–1.56), psoriasis (HR = 0.72; 95% CI: 0.23–2.27), diabetes (aHR = 0.97; 95% CI: 0.67–1.40), hypertension (aHR = 1.05; 95% CI: 0.76–1.44), myocardial infarction (aHR = 0.82; 95% CI: 0.63–1.06), stroke (aHR = 0.83; 95% CI: 0.62–1.12), or IBS (HR = 0.94; 95% CI: 0.61–1.45). Similarly, no association of CDI with FMT (vs. mrCDI without FMT) and diabetes (aHR = 0.92; 95% CI: 0.27–3.11), hypertension (aHR = 1.41; 95% CI: 0.64–3.15), stroke (aHR = 1.27; 95% CI: 0.69–2.34) or IBS (aHR = 0.80; 95% CI: 0.26–2.46) was found. However, the incidence of myocardial infarction was increased following FMT (aHR = 1.68; 95% CI: 1.01–2.81).

Conclusion: Relative to those with Clostridioides difficile infection (CDI), persons with multiply recurrent CDI do not appear to be intrinsically at higher risk of cardiometabolic, immune-mediated diseases, or irritable bowel syndrome. However, those who underwent fecal microbiota transplantation for CDI had a higher incidence of myocardial infarction. Future studies should assess this association to assess reproducibility.

J.D. Lewis, M.D., Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA,

DOI: DOI: 10.1016/j.cgh.2020.12.004

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