Long-Term Follow-Up of Colonoscopic Fecal Microbiota Transplant for Recurrent Clostridium difficile Infection

Brandt, Lawrence J.; Aroniadis, Olga C.; Mellow, Mark H.; Kanatzar, Amy; Kelly, Colleen R.; Park, Tina; Stollman, Neil; Rohlke, Faith; Surawicz, Christina M.

doi:10.1038/ajg.2012.60

Cited by 600 publications

(517 citation statements)

References 24 publications

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“…In a recent series of 70 patients with RCDI, FMT was eff ective even in patients with the C. diffi cile NAP1 / BI / 027 strain ( 100 ). A retrospective multicenter follow-up study of RCDI patients treated with FMT demonstrated a 91 % primary cure rate and a 98 % secondary cure rate ( 101 ).…”

Section: Guidelines For CDImentioning

confidence: 99%

“…In the only such followup study to date, 77 patients had FMT and were followed for > 3 months (3 months to > 10 years). Of these 77 subjects, four developed an autoimmune disease (rheumatoid arthritis, Sj ö gren's syndrome, idiopathic thrombocytopenic purpura, and peripheral neuropathy) at some time aft er the FMT, although a clear relationship between the new disease and the FMT was not evident ( 101 ). RCTs are necessary to prove the effi cacy of FMT and to determine the optimal route of administration among other variables and safety in immunosuppressed patients needs to be established.…”

Section: Treatment Of ≥ 3 CDI Recurrencesmentioning

confidence: 99%

See 1 more Smart Citation

Guidelines for Diagnosis, Treatment, and Prevention of Clostridium difficile Infections

Surawicz

Brandt

Binion

et al. 2013

American Journal of Gastroenterology

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Clostridium diffi cile infection (CDI) is a leading cause of hospital-associated gastrointestinal illness and places a high burden on our health-care system. Patients with CDI typically have extended lengths-of-stay in hospitals, and CDI is a frequent cause of large hospital outbreaks of disease. This guideline provides recommendations for the diagnosis and management of patients with CDI as well as for the prevention and control of outbreaks while supplementing previously published guidelines. New molecular diagnostic stool tests will likely replace current enzyme immunoassay tests. We suggest treatment of patients be stratifi ed depending on whether they have mild-to-moderate, severe, or complicated disease. Therapy with metronidazole remains the choice for mildto-moderate disease but may not be adequate for patients with severe or complicated disease. We propose a classifi cation of disease severity to guide therapy that is useful for clinicians. We review current treatment options for patients with recurrent CDI and recommendations for the control and prevention of outbreaks of CDI. Am J Gastroenterol 2013; 108:478-498; doi: 10.1038/ajg.2013 12. In patients in whom oral antibiotics cannot reach a segment of the colon, such as with Hartman's pouch, ileostomy, or colon diversion, vancomycin therapy delivered via enema should be added to treatments above until the patient improves. (Conditional recommendation, low-quality evidence)13. The use of anti-peristaltic agents to control diarrhea from confi rmed or suspected CDI should be limited or avoided, as they may obscure symptoms and precipitate complicated disease. Use of anti-peristaltic agents in the setting of CDI must always be accompanied by medical therapy for CDI. (Strong recommendation, low-quality evidence) Management of severe and complicated CDI14. Supportive care should be delivered to all patients and includes intravenous fl uid resuscitation, electrolyte replacement, and pharmacological venous thromboembolism prophylaxis. Furthermore, in the absence of ileus or signifi cant abdominal distention, oral or enteral feeding should be continued. 17. Vancomycin delivered orally (500 mg four times per day) and per rectum (500 mg in a volume of 500 ml four times a day) plus intravenous metronidazole (500 mg three times a day) is the treatment of choice for patients with complicated CDI with ileus or toxic colon and / or signifi cant abdominal distention. (Strong recommendation, low-quality evidence)18. Surgical consult should be obtained in all patients with complicated CDI. Surgical therapy should be considered in patients with any one of the following attributed to CDI: hypotension requiring vasopressor therapy; clinical signs of sepsis and organ dysfunction (renal and pulmonary); mental status changes; white blood cell count ≥ 50,000 cells / μ l, lactate ≥ 5 mmol / l; or failure to improve on medical therapy after 5 days. (Strong recommendation, moderate-quality evidence) Management of recurrent CDI (RCDI)19. The fi rst recurrence of CDI can be treated ...

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Section: Guidelines For CDImentioning

confidence: 99%

Section: Treatment Of ≥ 3 CDI Recurrencesmentioning

confidence: 99%

Guidelines for Diagnosis, Treatment, and Prevention of Clostridium difficile Infections

Surawicz

Brandt

Binion

et al. 2013

American Journal of Gastroenterology

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1,457

1,408

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“…Brandt et al, who conducted a multi-center long-term follow-up study of patients with rCDI previously treated with FMT, with a follow-up period ranging from 3 to 68 months, found a primary cure rate of 91 % among the 77 respondents. In addition, no definite adverse effects were noted, with 53 % of patients indicating a preference for FMT as first-line treatment if CDI were to recur [80]. To date, cases of death attributable to FMT due to aspiration pneumonia related to sedation and bacteremic toxic megacolon have been isolated, but underscore the need for robust follow-up to expand the safety data [81][82][83].…”

Section: Safetymentioning

confidence: 99%

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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“…This list will likely grow when the uncultured, undefined species are characterized. On the other hand, many human diseases are associated with altered gut microbiome and in some cases causal relationships were observed, such as Clostridium difficile and diarrhea (5). In many circumstances, the disrupted gut microbiome could have an adverse effect on liver health as the bacterial metabolites and the bacterial cell components are drained to the liver through portal vein.…”

mentioning

confidence: 99%