Elsevier

Mayo Clinic Proceedings

Volume 88, Issue 8, August 2013, Pages 799-805
Mayo Clinic Proceedings

Original article
Fecal Microbiota Transplant for Recurrent Clostridium difficile Infection: Mayo Clinic in Arizona Experience

https://doi.org/10.1016/j.mayocp.2013.04.022Get rights and content

Abstract

Objective

To report the initial experience of treating recurrent Clostridium difficile infection (CDI) with fecal microbiota transplant (FMT) at Mayo Clinic in Arizona.

Patients and Methods

The study retrospectively reviewed FMTs performed at Mayo Clinic in Arizona between January 1, 2011, and January 31, 2013. All the recipients had multiple recurrent CDIs unresponsive to traditional antibiotic drug therapy. A standardized protocol was developed to identify patients, screen donors, perform FMT, and determine outcomes via telephone surveys.

Results

Thirty-one patients (mean ± SD age, 61.26±19.34 years) underwent FMT. Median time from index infection to FMT was 340 days. Ninety-seven percent (29 of 30) of patients reported substantial improvement or resolution of diarrhea (median time to improvement, 3 days), 74% (17 of 23) reported improvement or resolution of abdominal pain (median time to improvement, 3 days), and 55% (16 of 29) had improvement or resolution of fatigue (median time to improvement, 6 days). Three patients underwent repeated FMT owing to persistent symptoms; 2 reported improvement in diarrhea with the second therapy. No serious adverse events directly related to FMT were reported.

Conclusion

A standardized regimen of FMT for recurrent CDI is safe, is highly effective, and can be provided using a relatively simple protocol.

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

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