Gianluca Ianiro, MD; Rita Murri, MD; Giusi Desirè Sciumè, MD; Michele Impagnatiello, MD; Luca Masucci, MD; Alexander C. Ford, MBChB, MD; Graham R. Law, PhD; Herbert Tilg, MD; Maurizio Sanguinetti, MD; Roberto Cauda, MD, PhD; Antonio Gasbarrini, MD; Massimo Fantoni, MD; Giovanni Cammarota, MD
Disclosures: Dr. Sanguinetti reports grants from Recordati, Pfizer, and Menarini outside the submitted work. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-3635.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Catharine B. Stack, PhD, MS, Deputy Editor, Statistics, reports that she has stock holdings in Pfizer, Johnson & Johnson, and Colgate-Palmolive. Christina C. Wee, MD, MPH, Deputy Editor, reports employment with Beth Israel Deaconess Medical Center. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Yu-Xiao Yang, MD, MSCE, Deputy Editor, reports that he has no financial relationships or interest to disclose.
>Reproducible Research Statement: Study protocol and data set: Available from Dr. Ianiro (e-mail, email@example.com). Statistical code: Not available.
Corresponding Author: Gianluca Ianiro, MD, Digestive Disease Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168 Rome, Italy; e-mail, firstname.lastname@example.org.
Current Author Addresses: Drs. Ianiro, Murri, Sciumè, Impagnatiello, Masucci, Sanguinetti, Cauda, Gasbarrini, Fantoni, and Cammarota: Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168 Rome, Italy.
Dr. Ford: Bexley Wing, St. James's University Hospital Leeds, Leeds LS9 7TF, United Kingdom.
Dr. Law: Sarah Swift Building, University of Lincoln, Lincoln LN6 7TS, United Kingdom.
Dr. Tilg: Department of Internal Medicine I, Gastroenterology, Hepatology, Metabolism & Endocrinology, Anichstrasse 35, 6020 Innsbruck, Austria.
Author Contributions: Conception and design: G. Ianiro, R. Murri, L. Masucci, A.C. Ford, M. Fantoni, G. Cammarota.
Analysis and interpretation of the data: G. Ianiro, R. Murri, A.C. Ford, G.R. Law, G. Cammarota.
Drafting of the article: G. Ianiro, A.C. Ford, G.R. Law, L. Masucci, G. Cammarota.
Critical revision of the article for important intellectual content: G. Ianiro, R. Murri, A.C. Ford, G.R. Law, H. Tilg, R. Cauda, M. Sanguinetti, M. Fantoni, A. Gasbarrini, G. Cammarota.
Final approval of the article: G. Ianiro, R. Murri, G.D. Sciumè, M. Impagnatiello, L. Masucci, A.C. Ford, G.R. Law, H. Tilg, M. Sanguinetti, R. Cauda, A. Gasbarrini, M. Fantoni, G. Cammarota.
Provision of study materials or patients: G. Ianiro, R. Murri, M. Impagnatiello, R. Cauda, M. Sanguinetti, A. Gasbarrini, M. Fantoni, G. Cammarota.
Statistical expertise: A.C. Ford, G.R. Law.
Administrative, technical, or logistic support: G. Ianiro, G. Cammarota, A. Gasbarrini, M. Sanguinetti, M. Fantoni, R. Cauda, L. Masucci, A.C. Ford.
Collection and assembly of data: G. Ianiro, R. Murri, G.D. Sciumè, M. Impagnatiello, M. Sanguinetti, M. Fantoni, G. Cammarota.
Clostridioides difficile infection (CDI) is a risk factor for bloodstream infection (BSI). Fecal microbiota transplantation (FMT) is more effective than antibiotics in treating recurrent CDI, but its efficacy in preventing CDI-related BSI is uncertain.
To assess incidence of primary BSI in patients with recurrent CDI treated with FMT versus antibiotics.
Prospective cohort study. Patients treated with FMT and those treated with antibiotics were matched on propensity score.
Single academic medical center.
290 inpatients with recurrent CDI (57 patients per treatment in matched cohort).
FMT or antibiotics.
The primary outcome was primary BSI within 90 days. Secondary outcomes were length of hospitalization and overall survival (OS) at 90 days.
Of the 290 patients, 109 were treated with FMT and 181 received antibiotics. Five patients in the FMT group and 40 in the antibiotic group developed BSI. Because of differences in the patients treated with FMT versus antibiotics in many baseline characteristics, including number of recurrences and CDI severity, comparative analyses were limited to the matched cohort. Risk for BSI was 23 percentage points (95% CI, 10 to 35 percentage points) lower in the FMT group; the FMT group also had 14 fewer days of hospitalization (CI, 9 to 20 fewer days) and a 32–percentage point increase in OS (CI, 16 to 47 percentage points) compared with the antibiotic group.
Nonrandomized study with potential for unmeasured or residual confounding; limited generalizability of the propensity score–matched cohort.
In a propensity score–matched cohort, patients with recurrent CDI treated with FMT were less likely to develop primary BSI.
Ianiro G, Murri R, Sciumè GD, et al. Incidence of Bloodstream Infections, Length of Hospital Stay, and Survival in Patients With Recurrent Clostridioides difficile Infection Treated With Fecal Microbiota Transplantation or Antibiotics: A Prospective Cohort Study. Ann Intern Med. 2019;171:695–702. [Epub ahead of print 5 November 2019]. doi: https://doi.org/10.7326/M18-3635
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Published: Ann Intern Med. 2019;171(10):695-702.
Published at www.annals.org on 5 November 2019
Hospital Medicine, Multi-Organ Failure and Sepsis, Pulmonary/Critical Care.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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