Fecal Microbiota Transplantation for Clostridium difficile Infection in Immunocompromised Patients - Safe or Risky?
Bibliographic record
Abstract
Introduction: In the past decade fecal microbiota transplantation (FMT) has emerged as an effective treatment for severe, refractory and recurrent Clostridium difficile infection (CDI). Given that immunosuppression (IS) is common in these patients and that the safety of FMT is not well studied in the context of IS, we conducted a systematic review to document the safety and efficacy of FMT for the treatment of CDI in patients with IS. Methods: A comprehensive search was performed by a medical librarian. Medline, Embase, Scopus, and Cochrane Library were queried from January 2010 to May 2018 utilizing both controlled vocabulary and natural language terms for FMT and CDI. IS was due to solid organ transplantation (SOT), stem cell transplantation, malignancy and its treatment, HIV, and immunosuppressive therapy. Patients receiving immunosuppressive agents with documented normal neutrophil count were excluded. The New Castle Ottawa Scale was used to grade the quality of included studies. Results: Out of the 749 studies initially screened, 21 studies of 268 patients met inclusion criteria. Characteristics of included studies are summarized in Table 1. SOT was the most common cause of IS (34%). The number of FMT procedures ranged from 1 to 6. Of the studies that documented the route of FMT delivery (145 patients), FMT was delivered by the lower GI tract route in 107 (74%). Overall clinical response was reported in 88% (237/268) (Table 2). Among patients with clinical response, recurrence rate was 7%. Three (1%) patients experienced FMT procedure-related adverse events; 2 aspiration and 1 superficial mucosal tear (Table 3). Of the patients with preexisting IBD (81), post-FMT IBD flare up occurred in 11 (14%). Twenty-two patients (8%) suffered transient GI complaints related to FMT. Two patients developed transient fever after FMT that was not attributed to other causes. Bacteremia related to FMT was not reported in any study. One patient had gastroenteritis after 3 days of FMT. New hospitalization related to FMT was required in 6 patients with good outcomes; 2 because of GI symptoms and 4 IBD flare up. All-cause mortality rate was 6%; 2 of which were a consequence of aspiration during colonoscopy for FMT. Conclusion: FMT is efficacious in the treatment of CDI in immunocompromised patients with a favorable post-FMT adverse effect profile. Adequate pre-operative preparation can mitigate the risk of intraprocedural adverse events.199_A Figure 1 No Caption available.199_B Figure 2 No Caption available.199_C Figure 3 No Caption available.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.041 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.004 | 0.003 |
| Bibliometrics | 0.004 | 0.005 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".