A mathematical model to evaluate the routine use of fecal microbiota transplantation to prevent incident and recurrent Clostridium difficile infection.

Published

Journal Article

OBJECTIVE: Fecal microbiota transplantation (FMT) has been suggested as a new treatment to manage Clostridium difficile infection (CDI). With use of a mathematical model of C. difficile within an intensive care unit (ICU), we examined the potential impact of routine FMT. DESIGN, SETTING, AND PATIENTS: A mathematical model of C. difficile transmission, supplemented with prospective cohort, surveillance, and billing data from hospitals in the southeastern United States. METHODS: Cohort, surveillance, and billing data as well as data from the literature were used to construct a compartmental model of CDI within an ICU. Patients were defined as being in 1 of 6 potential health states: uncolonized and at low risk; uncolonized and at high risk; colonized and at low risk; colonized and at high risk; having CDI; or treated with FMT. RESULTS: The use of FMT to treat patients after CDI was associated with a statistically significant reduction in recurrence but not with a reduction in incident cases. Treatment after administration of high-risk medications, such as antibiotics, did not result in a decrease in recurrence but did result in a statistically significant difference in incident cases across treatment groups, although whether this difference was clinically relevant was questionable. CONCLUSIONS: Our study is a novel mathematical model that examines the effect of FMT on the prevention of recurrent and incident CDI. The routine use of FMT represents a promising approach to reduce complex recurrent cases, but a reduction in CDI incidence will require the use of other methods to prevent transmission.

Full Text

Duke Authors

Cited Authors

  • Lofgren, ET; Moehring, RW; Anderson, DJ; Weber, DJ; Fefferman, NH

Published Date

  • January 2014

Published In

Volume / Issue

  • 35 / 1

Start / End Page

  • 18 - 27

PubMed ID

  • 24334794

Pubmed Central ID

  • 24334794

Electronic International Standard Serial Number (EISSN)

  • 1559-6834

Digital Object Identifier (DOI)

  • 10.1086/674394

Language

  • eng

Conference Location

  • United States