Clinical Outcomes After Faecal Microbiota Transplant by Retention Enema in both Immunocompetent and Immunocompromised Patients with Recurrent Clostridioides difficile Infections at an Academic Medical Center.

BACKGROUND Recurrent Clostridioides difficile infection (CDI) is one of the most common and challenging infections to treat in healthcare facilities. Faecal microbiota transplantation (FMT) is recommended as a definitive treatment option. METHODS We performed a retrospective review of 50 patients from January 2015 to December 2019 who underwent FMT for recurrent CDI. Primary outcome was recurrence of CDI within 12-weeks of FMT and secondary outcomes were the need for repeat FMT, serious adverse outcomes related to FMT and all-cause mortality. RESULTS 50 charts were reviewed, of which 47 cases comprising 17 immunocompromised patients treated with FMT via retention enema were included in the study. Majority of the patients had ≥3 recurrent CDIs (62%). Nine (19%) patients failed to respond to 1st FMT and 5 underwent repeat FMT within 4-12 weeks. The cure rate was 81% after 1st FMT (38/47) and 91% post 2nd FMT treatment (43/47). Serious adverse events occurred in 2% and all cause-mortality was 2%, at 90-day follow up. CONCLUSION Our study demonstrates safety and efficacy of FMT administered via retention enema, a simple bedside procedure, for treatment and prevention of recurrent non-severe and severe CDI with overall cure rate of 91%.