Bacteriotherapy for Chronic Relapsing Clostridium Difficile Diarrhoea in Six Patients

Tvede, Michael; Rask-Madsen, J

doi:10.1016/s0140-6736(89)92749-9

Cited by 441 publications

(261 citation statements)

References 15 publications

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“…was essential in normal colonic function and in colonic resistance to reinfection with C. difficile. Of note, one of the five patients had failed to improve with two fecal enemas, but did so with administration of this mixture of cultured bacteria [95].…”

Section: Microbial Ecosystem Therapeuticsmentioning

confidence: 92%

“…In 1989, the authors isolated ten enteric facultative aerobic and anaerobic bacterial strains from human feces, among which three of the selected strains inhibited the in vitro growth of C. difficile (R. productus, C. bifermentans, and an E. coli strain), whereas the six C. difficile strains inhibited the in vitro growth of all Bacteroides species [95]. Given that none of the six patients with recurrent CDI had this predominant colonic species in their gut prior to bacteriotherapy, and all had complete clinical recovery, with negative C. difficile toxin and evidence of sustained recolonization with Bacteroides sp.…”

Section: Microbial Ecosystem Therapeuticsmentioning

confidence: 99%

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Recurrent Clostridium difficile infection and the microbiome

2015

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The diverse and densely populated gastrointestinal microbiota is essential for the regulation of host physiology and immune function. As our knowledge of the composition and function of the intestinal microbiota continues to expand, there is new interest in using these developments to tailor fecal microbiota transplantation (FMT) and microbial ecosystem therapeutics (MET) for a variety of diseases. The potential role of FMT and MET in the treatment of Clostridium difficile infection (CDI)-currently the leading nosocomial gastrointestinal infection-has proven highly effective for recurrent CDI, and has emerged as a paradigm shift in the treatment of this disease. The current review will serve as a summary of the key aspects of CDI, and will introduce the essential framework and challenges of FMT, as is currently practiced. MET represents the progression of conventional bacteriotherapy that fundamentally capitalizes on the restorative properties of intestinal bacterial communities and may be viewed as the culmination of a rationally designed therapeutic modality. As our understanding of the composition and function of the intestinal microbiota evolves, it will likely drive next-generation microbiota therapies for a range of medical conditions, such as inflammatory bowel disease, obesity, and metabolic syndrome.

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Section: Microbial Ecosystem Therapeuticsmentioning

confidence: 92%

Section: Microbial Ecosystem Therapeuticsmentioning

confidence: 99%

Recurrent Clostridium difficile infection and the microbiome

2015

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“…they note that the solution of the disease occurs in about 92%, with adverse effects being uncommon and deaths are not usually due to the process, but parallel problems. The favorable changes that appear in the microbiota after transplantation have been documented [23][24][25], imt is one of the most commonly used procedures as emergency treatment for C. difficile infection, being imposed on other systems such as the use of monoclonal antibodies directed against toxin a and b, C. difficile vaccination [26]. imt is increasingly adopted by groups that treat patients with C. difficile infection, since the cure is more than 90%, as reported in multiple centers.…”

Section: Discussionmentioning

confidence: 99%

Pseudomembranous enterocolitis cured with three intestinal microbiota transplantations

Zamudio-Tiburcio¹,

Bermúdez-Ruiz²,

Reyes-López³

et al. 2018

Gastroenterol Hepatol Endosc

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SummaryWe present a unique case of a 82 years old women, with this newly described condition called "pseudomembranous enterocolitis cured with three transplants of intestinal microbi0ta (imt)." We evaluated the case of gaw, who had a perforates sigmoid diverticulum 10m days ago and had surgery with sigmoid resection, colostomy and hartmann's pouch. Her progress was good. However, she was given metronidazole and vancomycin, antibiotics that caused severe diarrhea and toxic state, a week postoperatively. Histopathological study of surgical specimen showed colonic mucosa extensively ulcerated and granulation tissue, fibrin and abundant neutrophils. Submucosal edema and acute periserositis. The muscular and mucosal layer had not alterations. A diagnosis of pseudomembranous enterocolitis (pm) was made. The patient had a toxic state, semi-conscious, diaphoretic and extensive erythema in the right forearm, with minor erythema at the left forearm and face, as well as perineal erythema, third degree edema in lower limbs, dehydrated and chest x-ray showed interstitial pneumonitis. She had a typical case of pm, and proceeded to perform an intestinal microbiota transplantation (imt) from healthy donors at clinical and laboratory studies. After that imt we performed colonoscopy, which showed at the course of transverse and right colon multiple plaques of whitish, cotton-like appearance, which protuded on the mucosal surface. This appearance were also seen at the left colon. We applied 400 ml. Of imt in the right colon and 100 ml at the hartmann's pouch of rectum. At the colonoscopy we placed a foley's catheter with an inflated balloon 20 ml. Also, solid petroleum jelly was left to prevent imt elimination. We removed all antibiotic treatment and replaced with probiotics, through the nasogastric tube.Three day later the patient had a better general condition, was conscious, with erythema limited to forearms, face and perineum, the lowers limb had no edema and she was better hydrated.The second imt was performed with another 400 ml. Of microbiota in right colon and 100 ml. At the hartmann's pouch. To prevent imt a 20 ml. Inflated balloon colostomy (foley's catheter) sealed with solid petroleum jelly.Three days later, a new imt was required under the same conditions as the former two imt. On this occasion the patient was fully aware, speaking and responded correctly to our questions. She had no erythema in her body, no edema at her legs and her chest x-ray had no pneumonitis, and showed only a small leak at the base of right lung.Further treatment without antibiotics, was with symbiotic by mouth and was under another treating team.We reviewed the literature, and we hope to encourage colleagues to use this procedure, which had similar results in the world. Presentation of the caseGaw, female, 82 years old with a history of sigmoid diverticulum perforation, peritonitis treated with sigmoid resection, colostomy and hartmann's pouch were given the following antibiotics: metronidazole, vancomycin which caused pseudomembranous enteroc...

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“…The first successful application of FMT in CDI was described by US physicians in 1958 (Eiseman et al ., 1958). In the late 1980s, Danish researchers developed a cocktail consisting of 10 faecal commensal bacterial species and demonstrated their clinical efficacy in CDI patients (Tvede and Rask‐Madsen, 1989). By cultivation microbiology, these researchers could associate Bacteroides (specifically B. ovatus, B. vulgatus and B. thetaiotaomicron ) with clinical recovery.…”

Section: Introducing Beneficial Bacteria Into the Gut Microbiomementioning

confidence: 99%

“…By cultivation microbiology, these researchers could associate Bacteroides (specifically B. ovatus, B. vulgatus and B. thetaiotaomicron ) with clinical recovery. Since C. difficile inhibited Bacteroides in vitro, the researchers suspected that a prior application of vancomycin against C. difficile is necessary to allow the outgrowth of the grafted Bacteroides strains which then inhibited the re‐growth of C. difficile (Tvede and Rask‐Madsen, 1989). Positive clinical effects in CDI were recently also documented along this line with synthetic microbiomes consisting of 33 defined strains (Petrof et al ., 2013) or an even larger, undefined set of gut commensals propagated in vitro (Jorup‐Rönström et al ., 2012).…”

Section: Introducing Beneficial Bacteria Into the Gut Microbiomementioning

confidence: 99%

Biome engineering‐2020

Brüssow

2016

Microbial Biotechnology

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SummaryThe gut microbiome research is going from a descriptive into an intervention phase. To optimize beneficial microbe–host interaction, we need to understand how to steer the system by modulating the nutrient input with which the system is literally fed (e.g. diets, fibres, prebiotics, human milk oligosaccharides), and we must learn how to modulate the composition of the gut microbiota by adding beneficial microbes (e.g. probiotics, faecal transplants) and by eliminating disturbing microbial members using, for example, bacteriophages in this highly complex ecosystem. The current status of the field is reviewed together with an outlook what might be expected until 2020, highlighting obstacles to progress and possible solutions to these problems.

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Bacteriotherapy for Chronic Relapsing Clostridium Difficile Diarrhoea in Six Patients

Cited by 441 publications

References 15 publications

Recurrent Clostridium difficile infection and the microbiome

Recurrent Clostridium difficile infection and the microbiome

Pseudomembranous enterocolitis cured with three intestinal microbiota transplantations

Biome engineering‐2020

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