Berks County Medical Society Medical Record Fall 2017 - 20

M e d i c a l R e c o R d F e at u R e

Each summer, the Reading
Health System's Student
Summer Training Program
provides valuable clinical and
research experience to a group
of highly capable and motivated
young people planning careers
in medicine. BCMS members
are among the physicians who
make this program possible,
and our Society is grateful to
the RHS for allowing the BCMS
President's Intern to participate
in the program's didactic
sessions. Presentations at these
sessions were given this year by
Dr. David George, Dr. Benjamin
Lloyd, Dr. Peter Schnatz, Dr.
Charles Barbera, and Dr. John
Sheffield. The research projects
completed by the student
trainees and their co-authors in
just 6 weeks are substantive and
include a wide variety of topics.
We are proud to present the
following abstracts of
these projects.

RHS Student S

Fecal Microbiota Transplantation
for Clostridium Difficile Infections in
Immunocompromised Patients:
A Systematic Review
by Oluwaseun Shogbesan, MD, MPH; Dilli Ram Poudel, MD;
Asad Jehangir, MD; Gbenga Shogbesan, MD; Samjeris Victor,
Anthony Donato, MD, MHPE
The Reading Hospital, Department of Internal Medicine
Introduction: Fecal microbiota transplantation (FMT) is proven to be effective in recurrent
Clostridium difficile infection (CDI), with resolution in 80% to 90% of patients. However,
since immunosuppressed patients were often excluded from FMT randomized trials,
guidelines recommend FMT with caution in this subgroup. We conducted a systematic review
of the literature of FMT for CDI specifically in immunocompromised patients, to quantify
the efficacy and safety in this population.
Methods: We searched MEDLINE, EMBASE, and Google scholar for English-language
articles published on FMT for treatment of CDI from inception through May 2017. We
defined immunocompromise as patients receiving immunosuppressive agents, HIV/AIDS,
inherited or primary immunodeficiency syndromes, malignancies, recipients of solid organ
transplants (SOT) or hematopoietic stem cell transplants (HSCT). Inflammatory bowel
disease patients not on immunosuppressants were excluded. We included patients of all ages.
Two reviewers independently assessed eligibility and conducted subsequent data extraction.
Resolution and adverse events rate were calculated.
Results: 50 studies were included, none of which were randomized designs. A total of 381
immunocompromised patients were included. Mean age was 58.2 years (range: 6.5 to 88
years). Reason for immune compromise included immunosuppressant use (74.2%); SOT
(22.9%); malignancy (13.0%); HSCT (2.8%); and HIV/AIDS (2.3%). Antibiotics were
tried in most (316, 82.9%) prior to FMT, of which 22% received 3 or more CDI treatments.
Seventy-nine percent received FMT via colonoscopy. Of the 330 (86%) who reported
outcomes, 227/261 (87%) reported resolution after first treatment, with 90% noting success
after multiple treatments. Of the 211 reporting adverse events, there were 2 deaths (0.9%), 2
colectomies (0.9%), 5 episodes of bacteremia or infection (2.4%) and 14 new hospitalizations
(6.6%).
Conclusion: FMT for treatment of CDI in immunocompromised patients is effective with
few serious infectious adverse events, and therefore should be cautiously considered in patients
with recurrence despite standard treatment.

Samjeris Victor is a member of the Class of 2018 at The Pennsylvania
State University in University Park, with a major in Biochemistry and
Molecular Biology. He attended Governor Mifflin Senior High School
and has served as a volunteer in multiple programs at The Reading
Hospital.
20

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Berks County Medical Society Medical Record Fall 2017

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