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A Mathematical Model to Evaluate the Routine Use of Fecal Microbiota Transplantation to Prevent Incident and Recurrent Clostridium difficile Infection

Published online by Cambridge University Press:  10 May 2016

Eric T. Lofgren ,
Rebekah W. Moehring ,
Deverick J. Anderson ,
David J. Weber  and
Nina H. Fefferman
Eric T. Lofgren*
Affiliation:
Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina
Rebekah W. Moehring
Affiliation:
Duke Infection Control Outreach Network, Duke University School of Medicine, Durham, North Carolina
Deverick J. Anderson
Affiliation:
Duke Infection Control Outreach Network, Duke University School of Medicine, Durham, North Carolina
David J. Weber
Affiliation:
Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
Nina H. Fefferman
Affiliation:
Department of Ecology, Evolution, and Natural Resources, Rutgers University, New Brunswick, New Jersey
*
4501 Connecticut Avenue NW, #411, Washington, DC 20008 (eric.lofgren@gmail.com)
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Abstract

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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.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 1 , January 2014 , pp. 18 - 27
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2014

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