Successful Treatment of Pseudomembranous Colitis with Fecal Microbiota Transplantation – A Case Study on A Patient Rescued by Extracorporeal Cardiopulmonary Resuscitation After Cardiac Arrest

Abstract

Background: Pseudomembranous colitis (PMC) is an opportunistic, nosocomial infection caused by Clostridium difficile. Case Report: Here we described a patient who developed PMC during her recovery from cardiac arrest. A 16-year-old female high school student experienced sudden cardiac arrest. Spontaneous circulation was not returned by standard cardiopulmonary resuscitation. After her admission to the emergency unit, her cardiac function and neurologic function were finally resumed by extracorporeal cardiopulmonary resuscitation (ECPR); however, after 14 days, her recovery was complicated with excessive diarrhea and shock. Colonoscopy confirmed the diagnosis of PMC. Metronidazole and vancomycin were immediately administered; however, the treatment did not result in any improvement. Fecal microbiota transplantation was then performed, and after 4 transplantations, her diarrhea was significantly ameliorated. After hospital stay for 135 days, the patient was finally discharged with grade II brain function. She later recovered self-care ability in follow-up. Conclusions: The patient suffered from a long-term gastrointestinal ischemia-hypoxia resulting from cardiac arrest. The use of broad-spectrum antibiotics in the later treatment led to refractory PMC, which was successfully managed by multiple fecal microbiota transplantation.

Role of Fecal Microbiota Transplantation in Reducing Clostridioides difficile Infection-Associated Morbidity and Mortality: A Systematic Review

“…Long-term antibiotic use was another important element. She presented with intractable diarrhea, fever, hematochezia, electrolyte imbalances, peritonitis, and sepsis [ 17 ].…”

“…One study mentioned starting with 500 milligrams intravenous metronidazole three times a day and 125 milligrams oral vancomycin four times a day for 10 days as initial treatment [ 5 ]. Another study provides the alternative view that antibiotics can further reduce intestinal flora, worsening the infection [ 17 ]. Taking both points of view into account, an ideal choice of antibiotic would be fidaxomicin.…”

“…Vancomycin can also be given rectally in patients with reduced gastrointestinal motility [ 16 ]. Metronidazole is also a treatment option, but many studies preferred vancomycin over metronidazole as they believed the former had higher rates of cure for C. difficile related colitis [ 17 ]. Other possible pharmacological options include rifaximin, tigecycline, nitazoxanide, and teicoplanin.…”

“…In a study conducted in 2016, a patient with toxic megacolon underwent laparoscopic colectomy with loop ileostomy as the patient had pre-existing ileus, and the vancomycin lavage was done through the ileostomy tube [ 18 ]. Despite surgery, the patient continued to have diarrhea, and hence the option of FMT was considered [ 17 ].…”

“…Sometimes FMT requires multiple sittings to achieve cure. A study conducted by Huang et al required the patient to have four fecal microbiota transplants to resolve the infection completely [ 17 ].…”