Factors Associated with the Use of Fecal Microbiota Transplant in Patients with Recurrent Clostridium difficile Infections

OBJECTIVE. To identify the factors associated with first Clostridium difficile infection (CDI) that predict fecal microbiota transplantation (FMT) for recurrent CDI. DESIGN. We carried out a retrospective single-center cohort study to compare the clinical characteristics of 200 patients who underwent FMT for recurrent CDI to 75 patients who did not. SETTING. A single academic hospital in the United States. PATIENTS. Adult patients. RESULTS. The time from first to second CDI correlated to subsequent FMT use. Concomitant inflammatory bowel disease (IBD; P = .002), use of immunosuppressive therapy (P = .04), and use of metronidazole within 2 months before the first CDI (P = .02) correlated positively to subsequent FMT in univariate analysis. The use of oral vancomycin for first CDI was more common in those who required FMT than those who did not in univariate (P = .02) and multivariate (P = .03) analyses. In contrast, intravenous vancomycin use within 2 months before the first CDI reduced the risk for FMT in univariate P =. 000003) and multivariate (P = .0001) analyses. Black patients with recurrent CDI were less likely to receive FMT than white patients (P = .00005). Patients who received FMT were also less likely to have comorbidities. CONCLUSIONS. This study provides important insights into the factors predictive for FMT in patients with recurrent CDI and highlights the potential racial and medical characteristics that affect the access of the patients to FMT.