Fecal Microbiota Transplant to Treat Recurrent Clostridium difficile Infections

Abstract

C lostridium difficile infections (CDIs) are some of the most common health care-associated infections in hospitalized patients 1-8 and in patients residing in nursing homes. 9-11 According to estimates, the diagnosis and treatment of CDIs cost more than $3.2 billion annually in the United States, 2,4,11,12 with approximately 333 000 cases and 15 000 to 20 000 deaths per year. 2,4,[13][14][15] When the diarrhea associated with CDIs becomes severe and causes complications, the infections become life-threatening and are a marked cause of morbidity and death in hospitalized patients. [1][2][3][4] The incidence of severe and recurrent CDIs (RCDIs) has increased because of a new hypervirulent strain of C difficile that is less responsive to traditional medications. Patients with RCDI often are treated in an intensive care unit. Fecal microbiota transplant (FMT), also called fecal bacteriotherapy, is an adjunctive, costeffective treatment for patients with RCDI. 2,[12][13][14][15][16][17][18][19] Critical care nurses must understand the importance of a balanced gut microbiome 20,21 and how CDIs disrupt that balance. [22][23][24][25] Furthermore, the nurses must recognize the role of FMT in order to provide appropriate care, educate patients, and collaborate with health care professionals on the latest treatment options for patients with RCDI. Feature The prevalence of recurrent or refractory Clostridium difficile infection has been steadily increasing since 2000. Consequently, alternative treatments to the standard antibiotic therapies are now being considered. One alternative treatment is fecal microbiota transplant. Although fecal microbiota transplant is relatively new-and not appealing to most people-it has been around for many years and has great promise as an inexpensive, safe, and efficient treatment of refractory and recurrent C difficile infection. With a better understanding of the intricacies of the colonic microbiome and its role in colonic physiology and pathophysiology, critical care nurses will recognize that fecal microbiota transplant has the potential to become the standard of care for treatment of recurrent or refractory C difficile infection. The American College of Gastroenterology and the Infectious Diseases Society of America provide the latest treatment guidelines for care of patients with these clostridial infections. (Critical Care Nurse. 2015;35[2]:51-65) Fecal Microbiota Transplant to Treat Recurrent

Dissemination ofClostridium difficilein food and the environment: Significant sources ofC. difficilecommunity-acquired infection?

“…Within hospital environments there is significant personto-person or contact surface-to-person transmission of C. difficile (Boyle et al 2015). In principal, C. difficile could also be acquired and transferred within enclosed spaces such as domestic homes and residences.…”

Fecal microbiota transplantation in recurrent Clostridium difficile infection: the first prospective study of 30 patients in Romania

“…The treatment options for relapsing Clostridium difficile are limited. ACG (The American College of Gastroenterology) recommends FMT after the 3 rd relapse [16,17,18] in order to re-establish the normal composition of the intestinal flora, restore the metabolic balance and stimulate both cellular and humoral immune responses in the intestinal mucosa. The fecal matter transplantation has been used ever since the 4 th century in China, and it is increasingly accepted nowadays as a safe and effective method for the treatment of relapsing Clostridium difficile infections.…”

Treating Clostridium difficile infections: Should fecal microbiota transplantation be reclassified from investigational drug to human tissue?

“…Recurrent CDI has recently become more common due (in part) to a new, hyper-virulent strain that is less responsive to traditional antibiotic treatments. Recurrent CDI is also associated with a significantly increased risk of death compared with that in CDI patients who do not develop recurrence [10] , [11] .…”