Fecal Transplant for C. Diff Deemed Safe for Immunocompromised

Immunocompromised patients with Clostridium difficile infection may be safely treated with fecal transplant

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) It can be difficult to treat C. diff infection in people who are immunocompromised, meaning they have a weakened immune system. Researchers now think an increasingly common treatment may be safe for these immunocompromised patients.

Fecal transplantation is now commonly used to treat C. diff (Clostridium difficile), but doctors have been concerned that a fecal transplant could lead to further infections in people with weakened immune systems, such as those with HIV or kidney failure.

New research, however, found that fecal transplants may be safe for these people with compromised immune systems.

"If you have a C. diff infection, talk to a gastroenterologist about fecal transplantation."

This research was led by Colleen Kelly, MD, of Alpert Medical School of Brown University in Providence, Rhode Island.

C. difficile is an infection that causes frequent diarrhea, abdominal pain, nausea and fever. The infection is difficult to get rid of, and up to 20 percent of all people who have it will become infected again, research has shown.

people who have it, will have it again, research shows.

Doctors now often treat the infection with fecal transplantation when other treatment methods have failed. Fecal transplantation is when fecal bacteria from a healthy person are placed into the gastrointestinal tract of the person who is ill.

For people who have conditions that make them particularly susceptible to infection, such as HIV, cancer patients or those with end-stage kidney disease, fecal transplantation is often avoided because of concerns that the patients will develop new infections. However, this new small study suggests that fecal transplantation may be safe for these patients too.

Dr. Kelly and colleagues reviewed records of 75 adults and five children treated for C. difficile who were also immunocompromised. All of the participants had a fecal transplant and answered a 32-item questionnaire to provide demographic and pre- and post-transplant data. The average time between the procedure and the questionnaire was 11 months.

Overall, the success rate of fecal transplantation in this group was 89 percent.

Sixty-two patients did not have a recurrence  of C. difficile infection at least 12 weeks after the transplant, the researchers found. Twelve patients required a repeat transplant, and of these, eight had no further C. difficile infection.

Twelve people (15 percent) experienced a side effect within 12 weeks of the procedure, and 10 of these needed to be hospitalized.

There were two deaths. One of these deaths was unrelated to the transplant, while the other death occurred when the patient became unable to breathe when they were sedated for a fecal transplant administered during colonoscopy.

In a press release, Dr. Kelly noted that the study “demonstrated the effective use of fecal transplant for C. diff infection in immunocompromised patients with few undesired harmful effects, and, importantly, there were no related infectious complications in these high-risk patients.”

Dr. Kelly concluded, "The key message here is that physicians do not need to be afraid to use fecal transplant in patients who are immunocompromised. Our findings show fecal transplant is both safe and effective in immunocompromised patients."

This study was published in July in The American Journal of Gastroenterology.

The authors admitted to several potential competing interests, including doing work for various organizations and pharmaceutical companies. Study co-author Thomas Borody, MD, has patents filed in the field of fecal transplant.

Review Date: 
July 11, 2014
Last Updated:
July 13, 2014