Refractory pseudomembranous colitis that was treated successfully with colonoscopic fecal microbial transplantation

Shin, Junyoung; Ko, Eun Jung; Lee, Seung Ho; Shin, Jong Bum; Kim, Shin Il; Kwon, Kye Sook; Kim, Hyung Gil; Shin, Yong Woon; Bang, Byoung Wook

doi:10.5217/ir.2016.14.1.83

Cited by 9 publications

(7 citation statements)

References 22 publications

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“…Despite a high prevalence of C. difficile in Asia [27,28,30,35], reports of severe outcomes of CDI are rare. Few reports of PMC and toxic megacolon exist from Asian countries [36,37,38,39,40,41,42,43], suggesting they may be less commonly seen than in other regions. Where reports do appear, they are frequently associated with infection with A-B+ strains [36,40].…”

Section: Epidemiology Of CDI In Asiamentioning

confidence: 99%

Clostridium difficile in Asia: Opportunities for One Health Management

Collins

Riley

2018

TropicalMed

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Clostridium difficile is a ubiquitous spore-forming bacterium which causes toxin-mediated diarrhoea and colitis in people whose gut microflora has been depleted by antimicrobial use, so it is a predominantly healthcare-associated disease. However, there are many One Health implications to C. difficile, given high colonisation rates in food production animals, contamination of outdoor environments by use of contaminated animal manure, increasing incidence of community-associated C. difficile infection (CDI), and demonstration of clonal groups of C. difficile shared between human clinical cases and food animals. In Asia, the epidemiology of CDI is not well understood given poor testing practices in many countries. The growing middle-class populations of Asia are presenting increasing demands for meat, thus production farming, particularly of pigs, chicken and cattle, is rapidly expanding in Asian countries. Few reports on C. difficile colonisation among production animals in Asia exist, but those that do show high prevalence rates, and possible importation of European strains of C. difficile like ribotype 078. This review summarises our current understanding of the One Health aspects of the epidemiology of CDI in Asia.

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Section: Epidemiology Of CDI In Asiamentioning

confidence: 99%

Clostridium difficile in Asia: Opportunities for One Health Management

Collins

Riley

2018

TropicalMed

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“…In 1958, the first published medical report of FMT described rapid recovery of 4 patients with fulminant pseudomembranous colitis, after given stool enemas by Eiseman and colleagues. 22 Since then, only a few case reports, [23][24][25][26][27][28][29][30] and 2 small albeit impressive case series have been published: a retrospective multicenter experience of 17 patients with 88% cure rate 31 and a single center study of 14 patients with 79% success rate following administration of a single FMT. 32 In contrast to the remarkable case series, there have been 4 examples where a single FMT in severe CDI was only transiently effective with implications that holding the anti-CDI antibiotic may have led to a poor clinical outcome.…”

Section: Introductionmentioning

confidence: 99%

Fecal microbiota transplant in severe and severe-complicatedClostridium difficile: A promising treatment approach

et al. 2016

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Severe and severe-complicated Clostridium difficile infection (CDI) is associated with high morbidity and mortality. Colectomy is standard of care; however, post-surgical mortality rates approach 50%. Case reports suggest fecal microbiota transplant (FMT) is a promising treatment of severe and severe-complicated disease but there is a paucity of data. Here, we present a single center experience with a novel sequential FMT protocol for patients refractory to maximal medical therapy. This approach consists of at least one FMT delivered via colonoscopy with criteria for repeat FMT and continued vancomycin therapy based on clinical response and pseudomembranes. Our cohort included 57 consecutive inpatients diagnosed with severe or severe-complicated CDI and treated with FMT. Overall, 91% (52/57) experienced clinical cure at 1 month with a 100% cure rate among severe CDI (n = 19) patients and an 87% cure rate for severe-complicated CDI (n = 33) patients. For the cohort, the survival rate was 94.7% at 1 month and 78.6% at 3 months. There were no serious adverse events related to FMT including no procedure-related complications or perforation. There was no difference in outcome between fresh or frozen fecal material. Sequential FMT for inpatients with severe or severe-complicated CDI is promising and may be preferred over colectomy in certain patients.

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“…Despite its excellent outcomes in treating refractory/relapsing CDI, it has not been widely performed in South Korea. However, we were able to find a few cases [8][9][10] and one case series 11 in the Korean literature. Despite minimal publications regarding the use of FMT, its acceptance appears to be growing.…”

Section: Discussionmentioning

confidence: 88%

“…7 However, despite growing interest in FMT to treat refractory/relapsing CDI, it has not been widely used in Korea. We were able to find several cases [8][9][10] and one case series 11 in the literature. We share our experiences of nine patients with recurrent/relapsing CDI who were successfully treated using FMT.…”

Section: Introductionmentioning

confidence: 87%

Fecal Microbiota Transplantation for Refractory and RecurrentClostridium difficileInfection: A Case Series of Nine Patients

Bang

Park

Kim

et al. 2017

Korean J Gastroenterol

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Background/Aims: Fecal microbiota transplantation (FMT) is a highly effective therapy for refractory and recurrent Clostridium difficile infection (CDI). Despite its excellent efficacy and recent widespread use, FMT has not been widely used in South Korea thus far. We describe our experience with FMT to treat refractory/recurrent CDI. Methods: We conducted a chart review of patients who underwent FMT for refractory/recurrent CDI at Inha University Hospital, between March 2014 and June 2016. The demographic information, treatment data, and adverse events were reviewed. FMT was administered via colonoscopy and/or duodenoscopy. All stool donors were rigorously screened to prevent infectious disease transmission. Results: FMT was performed in nine patients with refractory/recurrent CDI. All patients were dramatically cured. Bowel movement was normalized within one week after FMT. There were no procedure-related adverse events, except aspiration pneumonia in one patient. During the follow-up period (mean 11.4 months), recurrence of CDI was observed in one patient at one month after FMT due to antibiotics. Conclusions: FMT is a safe, well-tolerated and highly effective treatment for refractory/recurrent CDI. Although there are many barriers to using FMT, we expect that FMT will be widely used to treat refractory/recurrent CDI in South Korea. (Korean J Gastroenterol 2017;69: 226-231)

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Refractory pseudomembranous colitis that was treated successfully with colonoscopic fecal microbial transplantation

Cited by 9 publications

References 22 publications

Clostridium difficile in Asia: Opportunities for One Health Management

Clostridium difficile in Asia: Opportunities for One Health Management

Fecal microbiota transplant in severe and severe-complicatedClostridium difficile: A promising treatment approach

Fecal Microbiota Transplantation for Refractory and RecurrentClostridium difficileInfection: A Case Series of Nine Patients

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