Fecal microbiota transplant by push enteroscopy to treat diarrhea caused by Clostridium difficile

Abstract

Clostridium difficile is the major etiological agent of pseudomembranous colitis and is found in up to 20% of adult inpatients. The recommended treatment is antibiotic therapy with metronidazole and/or vancomycin. However, the recurrence rate may reach up to 25% and it increases in each episode. The newest alternative to treat diarrhea due to recurrent Clostridium difficile is fecal microbiota transplantation. The procedure was performed in 12 patients, with a 6-month follow-up on 10 of them. Of the ten cases, bacterial recurrence was diagnosed in only one patient, after a course of antibiotic to treat urinary tract infection, without presenting with diarrhea. The particularity of our study, besides being an unprecedented event in South America, is the way to perform the infusion of fecal microbiota by enteroscopy.

Structuring a Fecal Microbiota Transplantation Center in a University Hospital in Brazil

“…Ganc et al, in 2015, published a successful Brazilian experience of 12 patients who underwent FMT by endoscopic infusion in the proximal jejunum. The resolution rate was similar to that described by other routes (36) . The endoscopic route, whether superior or inferior, should be performed only by trained endoscopists to reduce the risk of complications (22) .…”

“…There are few reports of fecal transplantation in our country. So, as far as we know, only one study has been fully published in 2015, describing the experience of 12 patients with CDI undergoing transplantation in São Paulo city, with a success rate of 90% (36) . In all these cases, the procedure was not performed from a stool bank, a premise for structuring a fecal microbiota transplantation center based on international recommendations.…”

Systematic review with meta‐analysis: the efficacy of faecal microbiota transplantation for the treatment of recurrent and refractory Clostridium difficile infection

“…Twenty‐four studies allowed more than one infusion/treatment of FMT in the event of failure of response. Of the 13 studies that only performed a single infusion of FMT nine were done using the lower GI route, three used only the upper GI route and one used either route . In the remaining studies, FMT was administered up to four times for recurrent or unresolved symptoms.…”

Nutrição Enteral: elaboração de um protocolo clínico de tratamento de diarreia em Terapia Nutricional Enteral

“…Quando há o diagnóstico positivo para infecção por C. difficile a equipe médica deve suspender a antibioticoterapia, para evitar que o paciente fique mais suscetível a complicações graves. Imediatamente inicia-se uma nova conduta medicamentosa utilizando Metronidazol e/ou Vancomicina, medicações desenvolvidas para tratar esse tipo de bactéria 28,29 .…”

“…Também pode-se fazer uso da Fidaxomicina, pois o mesmo diminui a chance de acometimento a uma nova infecção e de debilitar mais a saúde do paciente, mas não é um medicamento fácil de ser encontrado 28,29 .…”