Factors Associated with Failure of Fecal Microbiota Transplant for Recurrent Clostridioides difficile Infection

BackgroundClostridioides difficile infection (CDI) has emerged as a prevalent and recurrent antibiotic-associated infection. Fecal microbiota transplantation (FMT) is the most effective treatment for recurrent CDI (rCDI). Despite high success rates, FMT is ineffective in 5-20% of cases. Factors associated with failure have not been clearly defined. We seek to better understand factors predictive of FMT failure. MethodsA retrospective chart review was conducted on adult patients who were screened at the Complicated C. difficile Clinic at the University of Virginia Health System and received FMT for rCDI between 2013 and 2022. Primary outcome was failure of FMT, defined as either rCDI or all-cause death within one year. Results240 patients underwent FMT: 70.4% were female, median age was 68, and median episodes of CDI was 4. 24.6% experienced failure within the year (18.3% had rCDI and 7.1% died). Age 70 or older (p=0.007), male sex (p=0.013), [≥]4 episodes of CDI (p=0.010), hypertension (p=0.010), diabetes mellitus (p=0.002), malignancy (p=0.034), high thyroid-stimulating hormone (p=2.696x10-5), anemia (p=0.002), and low zinc (p=0.025) were significantly associated with FMT failure on univariate analysis; age 70 or older (OR=2.66 [1.29-5.67]), [≥]4 episodes of CDI (OR=3.13 [1.47-7.09]), and diabetes mellitus (OR=2.82 [1.25-6.50]) persisted to be associated with failure on multivariate analysis. ConclusionsOur study shows that FMT remains an effective treatment for rCDI. We highlight several factors associated with FMT failure, such as older age, [≥]4 episodes of CDI, anemia, elevated TSH, and low zinc, and the need for additional research to clearly define causality.