Successful Treatment of Fulminant Clostridium difficile Infection with Fecal Bacteriotherapy

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].…”

“…Upon receipt of FMT via enema, the patient's blood pressure stabilized, leukocyte count normalized, and oliguria resolved. The patient's bowel function returned, and he was taken off the vasopressors and venovenous hemofiltration [You et al 2008].…”

“…There was heterogeneity in the selection of fluids used to mix the suspension, including homogenized cow's milk [Gustafsson et al 1999], psyllium, and saline [Wettstein et al 2007], normal/sterile saline preparations [Bowden et al 1981;Paterson et al 1994;Schwan et al 1983;You et al 2008], or sterile water [Kassam et al 2012]. Many studies reported the use of multiple administrations of FMT [Borody et al 2001;Bowden et al 1981;Kassam et al 2012;Paterson et al 1994;Schwan et al 1983].…”

“…A total of 12 reports of lower GI tract FMT treating CDI were included in this review (see Table 2) [Borody et al 2001;Bowden et al 1981;Duplessis et al 2011;Gustafsson et al 1999;JorupRonstrom 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]. The main points of variation that were specific to enema, retention enema, or rectal tube methodology pertained to the number of FMTs used per patient (over varying durations of time), volume of mixture fluid, grams of feces, and total infused suspension volume.…”

“…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].…”