Disparities in FMT for Recurrent Clostridioides difficile


Social determinants such as housing and transportation were strong predictors of patients receiving fecal microbiota transplants (FMT).

What You Need to Know

There are growing concerns over health disparities and the impact of social determinants on health care outcomes.

The study discussed in the article explores the use of FMT as a treatment for recurrent C difficile infection (rCDI).

The study uses the Social Vulnerability Index (SPI) to assess disparities in FMT treatment.

Health disparities have been a subject coming into focus with more research looking into how social determinants affect individual populations’ health care.

Separately, fecal microbiota transplantation (FMT) has become a modality used to treat patients with recurrence of C difficile. A new study explored social determinants as potential risks for rCDI and treatment with FMT.

The study is being presented as an abstract at IDWeek 2023.

Investigators reviewed data from the Georgia Emerging Infections program which identifies cases of C difficile among residents of the 8 County Metropolitan Atlanta area. The investigators who were from Emory Healthcare collaborated with a local gastroenterology practice, and compared a list of patients that were known to be treated with FMT to a list of doses that were shipped from OpenBiome, one of the largest public stool banks. This was done over a period between 2016-2019.

“We estimated that we captured somewhere between 80% and 90% of FMTs administered during this period within our data set,” study author Michael H. Woodworth, MD, MSc, assistant professor, Emory University, said. “We then linked these two datasets for recurrent C difficile infection, and FMT receipt to evaluate for potential disparities, and estimate the frequency of CDI, FMT receipt using the SPI data that is provided by the CDC.”

Woodworth noted some takeaways.

“We were surprised to find that only 7% of patients with recurrent C difficile infection were treated with an FMT overall, but maybe more surprising was that only 40% of black patients were as likely to be treated with FMT,” Woodworth said. “After adjusting for other factors, like insurance. We used a CDC dataset called the social vulnerability index, or SPI, which ranks several variables of social vulnerability at the level of census tracts. And we found that SPI variables of housing and transportation, in particular were also strong predictors of FMT received.”

Contagion spoke to Woodworth who offered further insights on the study.

Click here for more coverage of IDWeek 2023.


Little K, Mehta N, et al. Evaluating Disparities in Recurrent Clostridioides difficile Infection (CDI) and Fecal Microbiota Transplant (FMT) Treatment using Geospatial and Social Vulnerability Analytic Tools. Presented at: IDWeek 2023. October 11-14, 2023; Boston, MA. Abstract 1929.

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