Fecal Flora Reconstitution for Recurrent Clostridium difficile Infection: Results and Methodology

Abstract

Fecal Flora Reconstitution is an effective, viable, and simple method of treatment for the difficult to treat patients with RCDI who fail standard therapy.

Fecal microbiota transplantation in relapsing Clostridium difficile infection

“…There have been successful results, defined as clearance of diarrhea, or negative C. difficile toxin assays, with FMT administered to the proximal colon via colonoscope (see Table 1) [Arkkila et al 2010;Brandt et al 2012;Garborg et al 2010;Girotra et al 2011;Hamilton et al 2012;Hellemans et al 2009;Kelly et al 2012;Khoruts et al 2010;LundTonnesen et al 1998;Mattila et al 2011;Paterson et al 1994;Persky and Brandt, 2000;Rohlke et al 2010;Wettstein et al 2007;Yoon and Brandt, 2010], the distal lower GI tract via enema/rectal tube (see Table 2) [Borody et al 2001;Bowden et al 1981;Gustafsson et al 1999;Jorup-Ronstrom et al 2006;Kassam et al 2012;Louie, 2008;Paterson et al 1994;Schwan et al 1983;Silverman et al 2010;Tvede and Rask-Madsen, 1989;You et al 2008], and the upper GI tract via nasogastric (NG) tube/gastroscope (see Table 3) [Aas et al 2003;Duplessis et al 2011;Lund-Tonnesen et al 1998;MacConnachie et al 2009;Nieuwdorp et al 2008;Rubin et al 2009;Russell et al 2010].…”

“…Taking a different approach, clinicians often elect to utilize donations from individuals living in the same household, hypothesizing that in close living arrangements, and particularly with intimate partners, potential pathogens would likely already have been widely shared by both parties Rohlke et al 2010;Yoon and Brandt, 2010]. Donation from an intimate partner diminishes the risk of transferring an additional infectious agent (to which the recipient has not been previously exposed) into their GI tract.…”

“…The choice of donors varies among studies, most frequently the donor has been an intimate partner, housemate, or family member [Borody et al 2004;Gough et al 2011;Rohlke et al 2010], however several studies used volunteer donors [Aas et al 2003;Borody et al 2004;Bowden et al 1981;Eiseman et al 1958;Garborg et al 2010;Hamilton et al 2012;Kassam et al 2012;Lund-Tonnesen et al 1998]. Lund-Tonnesen and colleagues used homologous feces from 1 healthy donor in 18 patients (17 colonoscope, 1 gastroscope) [LundTonnesen et al 1998].…”

“…Conventional therapy for recurring CDI is in flux, but generally includes tapered/pulsed dosing of vancomycin [Cohen et al 2010]. However, current literature is suggesting increasingly that for patients with infections that fail to resolve with traditional antibiotic regimens, FMT's average cure rate of > 90% [Borody et al 2001;Bowden et al 1981;Garborg et al 2010;Girotra et al 2011;Gough et al 2011;Hellemans et al 2009;Khoruts et al 2010;Nieuwdorp et al 2008;Paterson et al 1994;Persky and Brandt, 2000;Rohlke et al 2010;Schwan et al 1983;Silverman et al 2010;Yoon and Brandt, 2010;You et al 2008], low cost, apparent safety, and readily available materials makes microbiota replacement through fecal transplantation an increasingly accepted option [Aas et al 2003;Brandt et al 2012;Rohlke et al 2010].…”

Abordaje multidisciplinario de la infección por Clostridium difficile

“…Dicha modificación permanece de manera duradera y además tiene efecto protector frente a la reinfección por C. difficile 1 . Se describen, en series de casos publicadas, diferentes formas de administración del inóculo bacteriano obtenido de heces de donantes sanos, ya sea a través de sonda nasogástrica, gastroscopia, sonda rectal o colonoscopia 1,[111][112][113][114] . La repoblación de la microbiota intestinal, lo cual confiere esa protección frente a infección por C. difficile, no es un concepto nuevo aunque es recientemente cuando resurge el interés por este tratamiento y, en consecuencia, existen al día de hoy numerosas publicaciones al respecto 115 .…”