Results of faecal donor instillation therapy for recurrent Clostridium difficile-associated diarrhoea

Abstract

We report a success rate of 83% with faecal donor instillation therapy (FDIT) in this retrospective study of 40 patients with recurrent Clostridium difficile-associated diarrhoea (CDAD), treated at a medium sized Norwegian hospital from 1994 through 2008. The stool transplant was instilled either in the duodenum through a gastroscope or in the colon through a colonoscope with next of kin or other household member as donor. In 29 cases (73%) the first treatment was successful, with no documented recurrence of diarrhoeal disease within 80 days. Of the 11 patients failing to respond to the first instillation treatment, 6 patients received a second instillation, 4 of which were successful. A total of 33 patients (83%) were successfully treated with FDIT. Of the 7 non-responders, 5 were seriously ill due to long lasting diarrhoeal disease and co-morbidity and died within 80 days after the procedure, and 2 were believed to have inflammatory bowel disease with response to corticosteroid treatment. No adverse effects of FDIT were observed. In our experience the procedure is easy to perform, well tolerated, effective, and may be a valuable treatment option in selected cases.

Fecal microbiota transplantation in relapsing Clostridium difficile infection

“…There have been successful results, defined as clearance of diarrhea, or negative C. difficile toxin assays, with FMT administered to the proximal colon via colonoscope (see Table 1) [Arkkila et al 2010;Brandt et al 2012;Garborg et al 2010;Girotra et al 2011;Hamilton et al 2012;Hellemans et al 2009;Kelly et al 2012;Khoruts et al 2010;LundTonnesen et al 1998;Mattila et al 2011;Paterson et al 1994;Persky and Brandt, 2000;Rohlke et al 2010;Wettstein et al 2007;Yoon and Brandt, 2010], the distal lower GI tract via enema/rectal tube (see Table 2) [Borody et al 2001;Bowden et al 1981;Gustafsson et al 1999;Jorup-Ronstrom et al 2006;Kassam et al 2012;Louie, 2008;Paterson et al 1994;Schwan et al 1983;Silverman et al 2010;Tvede and Rask-Madsen, 1989;You et al 2008], and the upper GI tract via nasogastric (NG) tube/gastroscope (see Table 3) [Aas et al 2003;Duplessis et al 2011;Lund-Tonnesen et al 1998;MacConnachie et al 2009;Nieuwdorp et al 2008;Rubin et al 2009;Russell et al 2010].…”

“…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].…”

“…Various filtration systems have been constructed, and depending on the resources at hand, will vary in cost from a few cents for disposable supplies to more extensive costs associated with reusable equipment. Some clinicians have crafted filtration devices with 4 × 4 sheets of gauze [Brandt et al 2012;Garborg et al 2010;Kelly et al 2012;Nieuwdorp et al 2008;Rohlke et al 2010;Yoon and Brandt, 2010] or coffee filters [Aas et al 2003;Russell et al 2010], which are then secured over the top of the suspension container. The suspension can then be poured from the original container, through the filter, into the second container.…”

“…Conventional therapy for recurring CDI is in flux, but generally includes tapered/pulsed dosing of vancomycin [Cohen et al 2010]. However, current literature is suggesting increasingly that for patients with infections that fail to resolve with traditional antibiotic regimens, FMT's average cure rate of > 90% [Borody et al 2001;Bowden et al 1981;Garborg et al 2010;Girotra et al 2011;Gough et al 2011;Hellemans et al 2009;Khoruts et al 2010;Nieuwdorp et al 2008;Paterson et al 1994;Persky and Brandt, 2000;Rohlke et al 2010;Schwan et al 1983;Silverman et al 2010;Yoon and Brandt, 2010;You et al 2008], low cost, apparent safety, and readily available materials makes microbiota replacement through fecal transplantation an increasingly accepted option [Aas et al 2003;Brandt et al 2012;Rohlke et al 2010].…”

972 Predictors and Outcomes of Readmission for Clostridium difficile in a National Sample of Medicare Beneficiaries

“…4,5 Furthermore, the elderly are at increased risk for severe CD infections and morbidity and mortality related to CD. [6][7][8] Recurrent infections are concerning due to the risk of both adverse outcomes among individual patients with each subsequent occurrence and spread of CD to others due to incompletely eradicated infections. 9 Studies examining CD recurrence across all age groups have identified older age, severe CD infection, use of non-CD-related antibiotics, use of antacid medications, and hospital exposure as risk factors for CD recurrence.…”