Purpose: In recent years, there has been a dramatic increase in frequency and severity of Clostridium Difficile infection (CDI), as well as recurrent CDI (RCDI). Approximately 20% of patients that experience CDI will have a recurrence; of those, 50% will have multiple recurrences with resultant debility and, sometimes, death. Fecal bacteriotherapy (or fecal transplantation) administered via either nasogastric tube, rectal enema or colonscopically, has been reported to be successful in over 100 patients with RCDI. Methods: We report our experience with our 1st 13 patients treated with fecal bacteriotherapy at our institution between July 2009 and April 2010. 12 had RCDI and 1 refractory CDI. Unless deemed terminally ill, no patients were excluded from treatment because of co-morbidities. 12 of 13 patients were ill enough to have been hospitalized or homebound at the time of fecal bacteriotherapy. “Donors” underwent serologic (Hepatitis A,B,C; STS, HIV 1&2) and stool evaluation (CDT; culture for enteric pathogens; O&P). So that their pre-treatment status was known, patients also underwent serologic testing for Hepatitis A,B,C; STS and HIV 1&2. Donor exclusions: antibiotic use in prior 8 weeks; recent diarrhea or chronic diarrhea; immunologic disorder or use of immunosuppressant medications. Donor stool was collected on the morning of the patient's colonoscopy, liquefied with non-bacteriostatic saline to a thick liquid consistency that allowed aspiration into 60 ml syringes. Between 300 and 500ml were infused via biopsy channel of the colonoscope; approximetly 50% was placed in cecum-right colon; the remainder infused sequentially on withdrawal. Results: 13 patients (6 females, 7 males), aged 32-87 (mean 67) were treated. Patients with RCDI had experienced a mean of 4 prior episodes of CDI (range 3-7), over a mean of 11.5 months (range 3-24). To date, patients have been followed up for mean of 5 months (range 1-10). 12 of 13 experienced resolution of diarrhea; in 1, diarrhea persisted with stool CDT (+). Stool for CDT was negative in 10 of 10 patients tested ≥ 30 days post treatment. 3 patients have died (B strep pneumonia 1 month after FB; superior mesenteric vein thrombosis in patient with Crohn's disease 5 months after FB; ovarian cancer 7 months after FB). The patient with refractory CDI underwent subsequent successful liver transplantation. One patient relapsed at 7 months after FB. 2 patients required antibiotics during follow up, without diarrhea recurring. Conclusion: Colonoscopic Fecal Bacteriotherapy is effective in the treatment of recurrent and refractory CDI, even in patients with severe co-morbidities, with a success rate of 92% (12 of 13).
No takes yet. Share an insight, caveat, or question.
Mellow et al. (2010) studied this question.