Treating Clostridioides difficile infection is complicated in patients coinfected with COVID-19. However, a new study suggests a significant benefit of fecal microbiota transplant (FMT) in these coinfected patients.
Clostridioides difficile infection (CDI) is the most common hospital-acquired infection in the world. The bacterium causes severe diarrhea and colitis, and infection can be recurrent or fatal.
Among other complications, the COVID-19 pandemic has challenged the management of patients coinfected with COVID-19 and Clostridioides difficile. New research shows that intestinal microbiota plays a crucial role in the immune response to COVID-19 infection by modulating the inflammatory response.
Because the majority of CDIs are contracted in health care facilities, it is reasonable to investigate whether hospitalized COVID-19 patients were at risk for a CDI coinfection.
A new study looked at whether a fecal microbiota transplant (FMT) may benefit patients with this coinfection due to its known capacity for reducing circulating inflammatory markers as well as complications and recurrence rates in CDI.
“Clostridioides difficile preferentially affects elderly patients and causes a high mortality rate, especially in co-infection,” the study authors wrote.
This retrospective, single-center study included 86 patients, (46 in the study arm vs. 40 in the control arm) admitted in the Gastroenterology Department in the County Community Emergency Hospital of Sibiu between January 2020 and March 2022. Both arms of the study consisted of COVID-19 and CDI coinfected patients.
Three primary outcomes were identified: the reduction of inflammatory markers, the resolution of abdominal pain after treatment, and disease recurrence within 8 weeks after a previous episode after completion of initial treatment.
There was a notable difference in patients coming from rural areas (60.5%) compared with patients from urban environments (39.5%), however both groups had the same distribution pattern (P > 0.05), according to the study. Both groups also had the same percentage of patients (60.5%) with hypertension as a factor of severity, and type 2 diabetes.
Approximately 8% of the cases presented a stroke in their medical history, and obesity as a risk factor was noted in a slightly higher percentage for the FMT group (17.4% vs 15%). In the control group, there were 20 patients (50%) with moderate COVID-19 and 20% with severe disease. In the FMT group, 23 patients presented with a moderate form (50%), and 23 had a severe form.
The authors found a statistically significant improvement in inflammatory syndrome (C-reactive protein [CRP] and white blood cell [WBC] count) after FMT (P < 0.05). In the control group, 29 patients (72.5%) received metronidazole and vancomycin compared with the FMT group, in whom these antibiotics were only used in 1 patient (2.17%). Additionally, there was 1 case of relapse (2.17%) out of the 46 patients receiving an FMT, in contrast to 17 cases of recurrence (42.5% relapse rate) in the control group (P < 0.05).
More than 91% (p < 0.005) of FMT patients reported no abdominal pain post-treatment, whereas a significant number of patients treated with only antibiotics (82.5%) had persistent moderate pain (P < 0.05).
“It is acknowledged that SARS-CoV-2 and CDI co-infection challenge clinical management in the sense that abdominal cramping and pain may be more severe and longer lasting after the disease’s resolution. We recorded a statistically significant correlation between FMT and the reduction of abdominal pain for our patients at discharge,” the study authors wrote.
The study investigators highlighted the 97.82% success rate that was demonstrated regardless of age and comorbidities.
“The fecal microbiota transplantation approach shows promise regarding the safety and efficiency of treatment of CDI in patients with co-existing COVID-19. It offers a personalized therapeutic management strategy with multiple benefits like decreasing inflammatory syndrome, limiting the use of antibiotics, reducing relapse risk, and alleviating symptomatology,” the authors concluded.
Boicean A, Neamtu B, Birsan S, et al. Fecal microbiota transplantation in patients co-infected with SARS-CoV2 and Clostridioides difficile. Biomedicines. 11(1) https://doi.org/10.3390/biomedicines11010007
This article was originally published on Pharmacy Times.