Bacteriotherapy Using Fecal Flora

Borody, Thomas J.; Warren, Eloise F.; Leis, Sharyn; Surace, Rosa; Ashman, Ori; Siarakas, Steven

doi:10.1097/01.mcg.0000128988.13808.dc

Cited by 265 publications

(177 citation statements)

References 62 publications

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“…FMT appears to be safe, with no adverse eff ects or complications directly attributed to the procedure yet described in the existing literature ( 85,102 ). Th e potential for transmission of infectious agents is a concern, however, and a recent publication outlines rigorous screening of stool donors ' blood and stool for common bacterial and viral enteropathogens ( 85 ).…”

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

1,478

1,408

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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: 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

1,478

1,408

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“…Bowel lavage is not frequently utilized with FMT administered via NG tube, however one group reported utilizing bowel lavage prior to upper GI FMT in four patients [Nieuwdorp et al 2008]. Lavage may also have a benefit with enema preparations [Borody et al 2004[Borody et al , 2012. Clone library sequencing has shown that colonic mucosa-associated microbiota composition is altered by standard bowel preparation lavage [Harrell et al 2012], and therefore it could be surmised that it enhances the potential for FMT to provide a 'fresh start' in repopulating the colonic habitat of the recipient.…”

Section: Patient (Recipient) Pre/postpreparationmentioning

confidence: 99%

“…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].…”

Section: Donor Determinationmentioning

confidence: 99%

Fecal microbiota transplantation in relapsing Clostridium difficile infection

Rohlke

Stollman

2012

Therap Adv Gastroenterol

180

140

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Clostridium difficile infection rates are Climbing in frequency and severity, and the spectrum of susceptible patients is expanding beyond the traditional scope of hospitalized patients receiving antibiotics. Fecal microbiota transplantation is becoming increasingly accepted as an effective and safe intervention in patients with recurrent disease, likely due to the restoration of a disrupted microbiome. Cure rates of > 90% are being consistently reported from multiple centers. Transplantation can be provided through a variety of methodologies, either to the lower proximal, lower distal, or upper gastrointestinal tract. This review summarizes reported results, factors in donor selection, appropriate patient criteria, and the various preparations and mechanisms of fecal microbiota transplant delivery available to clinicians and patients.

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“…This kind of apparatus, therefore, may also provide a means for safely producing a human microbiota to be reintroduced into a human GIT. This process could be of great interest for several pathologies (for example, Clostridium difficile diarrhoea), using a faecal bacteriotherapy (Bakken, 2009;Borody et al, 2004) provided by a specially designed in vitro production system.…”

Section: Resultsmentioning

confidence: 99%