• Gianluca Ianiro, Rita Murri, Giusi Desirè Sciumè, Michele Impagnatiello, Luca Masucci, Alexander C Ford, Graham R Law, Herbert Tilg, Maurizio Sanguinetti, Roberto Cauda, Antonio Gasbarrini, Massimo Fantoni, and Giovanni Cammarota.
• Fondazione Policlinico Universitario Agostino Gemelli IRCCS UniversitàCattolica del Sacro Cuore, Rome, Italy (G.I., R.M., G.D.S., M.I., L.M., M.S., R.C., A.G., M.F., G.C.).
• Ann. Intern. Med. 2019 Nov 19; 171 (10): 695-702.

BackgroundClostridioides difficile infection (CDI) is a risk factor for bloodstream infection (BSI). Fecal microbiota transplantation (FMT) is more effective than antibiotics in treating recurrent CDI, but its efficacy in preventing CDI-related BSI is uncertain.ObjectiveTo assess incidence of primary BSI in patients with recurrent CDI treated with FMT versus antibiotics.DesignProspective cohort study. Patients treated with FMT and those treated with antibiotics were matched on propensity score.SettingSingle academic medical center.Patients290 inpatients with recurrent CDI (57 patients per treatment in matched cohort).InterventionFMT or antibiotics.MeasurementsThe primary outcome was primary BSI within 90 days. Secondary outcomes were length of hospitalization and overall survival (OS) at 90 days.ResultsOf the 290 patients, 109 were treated with FMT and 181 received antibiotics. Five patients in the FMT group and 40 in the antibiotic group developed BSI. Because of differences in the patients treated with FMT versus antibiotics in many baseline characteristics, including number of recurrences and CDI severity, comparative analyses were limited to the matched cohort. Risk for BSI was 23 percentage points (95% CI, 10 to 35 percentage points) lower in the FMT group; the FMT group also had 14 fewer days of hospitalization (CI, 9 to 20 fewer days) and a 32-percentage point increase in OS (CI, 16 to 47 percentage points) compared with the antibiotic group.LimitationNonrandomized study with potential for unmeasured or residual confounding; limited generalizability of the propensity score-matched cohort.ConclusionIn a propensity score-matched cohort, patients with recurrent CDI treated with FMT were less likely to develop primary BSI.Primary Funding SourceNone.

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