Relapsing Clostridium difficile Associated Disease Followed by a Registry and Fecal Microbiota Transplant Attitudes Questionnaire
Year: 2015
Type: article
Study design: Observational Study
Abstract: Background. Management of Clostridium difficile associated disease (CDAD) moving forward requires clear data delineating the treatment and outcomes related to current practices. With this critically ill population and the advent of new agents including fecal microbiota transplant (FMT), we must determine where these interventions shoud be utilized. CDAD registry data was previously reported after six months, and we now report our one-year follow-up of hospital acquired CDAD patients enrolled in the registry describing treatment, relapse, adjunctive therapy and attitudes toward FMT. Methods. Prospective observational study in an 1100 bed academic community health system. Patient enrollment between April 2013 and April 2014 included hospitalized patients >18 years, having a first episode CDAD, >3 stools/24 hours and a positive stool assay. Patients were excluded if there were barriers to follow up or anticipated <6-month survival. Telephone interviews were conducted weekly then monthly for 1 year to determine CDAD activity, wellness, and attitudes. Results. 158 patients were enrolled, and 113 were followed for a full 12 months. The all-cause mortality was 16%. Initial treatment included vancomycin (V) 19%, metronidazole (M) 55%, and combination (VM) 24%. Rifaximin or fidaxomicin were used for only 2% of patients. Treatment with combination therapy was more common in moderate/severe disease than mild disease (28% versus 13%). 43% of patients received probiotics at some point in care. Primary relapse rate was 20% (23 of 113), and of those, 22% (5 of 23) patients had a second relapse (overall 4%). Attitudes toward FMT were assessed in 92 of the 158 enrolled patients, and 52% (48 of 92) of patients would accept FMT if offered. Conclusion. The use of combination vancomycin/metronidazole is high and increasingly used in the severe CDAD patient. Our primary relapse rate of 20% appears to fit prior studies; however, our secondary relapse rate of 22% (4% overall) is lower than expected. 4% of our CDAD population are candidates for FMT based on strict hospital criteria (2 relapses). A high percentage of CDAD patients (52%) would accept FMT as treatment if offered. Disclosures. All authors: No reported disclosures.
Source: Open Forum Infectious Diseases
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $4,053
OpenAlex ID: W2344949585