Fecal microbiota transplantation for recurrent C difficile infection: Ready for prime time?

Abstract

Recurrent Clostridium difficile infection has been a major challenge for patients and clinicians. Recurrence of infection after treatment with standard antibiotics is becoming more common with the emergence of more-resistant strains of C difficile. Fecal microbiota transplantation is an alternative treatment for recurrent C difficile infection, but it is not yet widely used.

Fecal Microbiota Transplant to Treat Recurrent Clostridium difficile Infections

“…Because of their durability and strength, spores germinate, and organisms rapidly outgrow the normal intestinal flora. 1,3,8,9,[12][13][14][15][16][17] Although C difficile flourishes in anaerobic conditions such as the gut, it can survive on a variety of surfaces for more than 3 months. [1][2][3][4][5][6][7]31 The spores are difficult to eradicate from surfaces, creating an easy way to 138/min with sinus tachycardia, respirations 18/min, and oxygen saturation 96% on room air as measured by pulse oximetry.…”

“…Of more concern are the number of community-acquired cases and the number of cases resistant to metronidazole, the most common treatment for CDI. 14,18,35 About half of the infections occur in patients less than 65 years old 5 ; however, patients more than 65 years old account for about 90% of the deaths due to CDI. 2,4,10,11 The highest incidence of CDI is among elderly hospitalized patients (25% of all cases) 2,4 ; the remaining 75% of cases occur in patients in nursing homes 9,11,36 or in patients who recently visited doctors' offices and clinics.…”

“…The ACG recommends FMT after a third RCDI 2,7,16 in order to reestablish the normal composition of the gut flora, restore the balance in metabolism, and stimulate both cellular and humoral immune responses in the gut mucosa. 3,4,7,13,14,38 Although fecal transplants have been used since the 4th century in China, they are now becoming more widely accepted as a safe and effective method of treating RCDI. 4,13,[38][39][40][41][42][43][44][45][46] Traditional pharmacological treatment of CDI should be started only after testing for C difficile is completed.…”

“…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.…”

“…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.…”