Original articleFecal Microbiota Transplant for Recurrent Clostridium difficile Infection: Mayo Clinic in Arizona Experience
Section snippets
Patients and Methods
We conducted a retrospective review of our experience performing FMT for recurrent CDI at Mayo Clinic in Arizona between January 1, 2011, and January 31, 2013. Approval was obtained from Mayo Clinic Institutional Review Board.
Results
Between January 1, 2011, and January 31, 2013, 31 patients underwent 34 FMTs. The mean ± SD age of the patients was 61.26±19.34 years, 45% (14 of 31) of patients were men, and 55% (17 of 31) of recipients had a gastrointestinal comorbidity, including diverticulosis (n=5), irritable bowel syndrome (n=5), ulcerative colitis (n=3), Crohn disease (n=1 inactive/n=1 active), gastroparesis (n=1), and coloanal fistula (n=1). Several patients had previous gastrointestinal tract surgery, including 3 with
Discussion
Treatment of recurrent CDI is challenging for patients and physicians. Patients with recurrent disease often are taking prolonged or combination antimicrobial agents only to relapse when therapies targeting CDI are discontinued. With traditional antibiotic drug treatment regimens, it is estimated that 15% to 30% of patients will have a recurrence of CDI, usually within a month of the index infection.17 Furthermore, of patients with a recurrence, 40% will have a second, and of these, 65% will
Conclusion
Despite the reported benefits of FMT, many patients currently lack access to centers that perform this procedure. Most patients referred to Mayo Clinic in Arizona had been treated for almost a year with multiple expensive antibiotic drug regimens and had had numerous documented recurrences. A multidisciplinary FMT team consisting of a nurse coordinator, an endoscopy team, and infectious diseases and gastroenterology physicians allowed us to treat patients within approximately 2 weeks from their
References (26)
- et al.
Economic healthcare costs of Clostridium difficile infection: a systematic review
J Hosp Infect
(2010) Fecal bacteriotherapy for recurrent Clostridium difficile infection
Anaerobe
(2009)- et al.
Meta-analysis to assess risk factors for recurrent Clostridium difficile infection
J Hosp Infect
(2008) - et al.
The economic burden of Clostridium difficile
Clin Microbiol Infect
(2012) - et al.
Intestinal flora in the newborn infant with a description of a new pathogenic anaerobe, Bacillus difficile
Am J Dis Child
(1935) - et al.
Antibiotic-associated pseudomembranous colitis due to toxin-producing clostridia
N Engl J Med
(1978) - et al.
Increase in Clostridium difficile-related mortality rates, United States, 1999-2004
Emerg Infect Dis
(2007) - et al.
Comparison of the burdens of hospital-onset, healthcare facility-associated Clostridium difficile infection and of healthcare-associated infection due to methicillin-resistant Staphylococcus aureus in community hospitals
Infect Control Hosp Epidemiol
(2011) - et al.
The epidemiology of community-acquired Clostridium difficile infection: a population-based study
Am J Gastroenterol
(2012) - et al.
A randomized, double-blind, placebo-controlled pilot study to assess the ability of rifaximin to prevent recurrent diarrhoea in patients with Clostridium difficile infection
J Antimicrob Chemother
(2011)
The search for a better treatment for recurrent Clostridium difficile disease: use of high-dose vancomycin combined with Saccharomyces boulardii
Clin Infect Dis
Fecal enema as an adjunct in the treatment of pseudomembranous enterocolitis
Surgery
Systematic review of intestinal microbiota transplantation (fecal bacteriotherapy) for recurrent Clostridium difficile infection
Clin Infect Dis
Cited by (52)
Japanese Clinical Practice Guidelines for Management of Clostridioides (Clostridium) difficile infection
2022, Journal of Infection and ChemotherapyCurrent and future targets for faecal microbiota transplantation
2019, Human Microbiome JournalThe use of faecal microbiota transplant as treatment for recurrent or refractory Clostridium difficile infection and other potential indications: joint British Society of Gastroenterology (BSG) and Healthcare Infection Society (HIS) guidelines
2018, Journal of Hospital InfectionCitation Excerpt :Many of the suggestions are extended from established blood screening guidelines [106]. Case series almost universally screen for HIV, hepatitis B and hepatitis C as a minimum [40–42,44–47,51,54,57–60,64,66,77,79,86,88,90,91,107]; other studies (including the randomised trials) have a more thorough blood screening process [14–18]. Many studies have also included a ‘metabolic/general blood screen’, to select out donors with hitherto undiagnosed chronic illness.
Fecal Microbiota Transplantation as Therapy for Inflammatory Bowel Disease
2018, Interventional Inflammatory Bowel Disease: Endoscopic Management and Treatment of ComplicationsIs frozen fecal microbiota transplantation as effective as fresh fecal microbiota transplantation in patients with recurrent or refractory Clostridium difficile infection: A meta-analysis?
2017, Diagnostic Microbiology and Infectious Disease
For editorial comment, see page 782