A retrospective comparison of fecal microbial transplantation methods for recurrent Clostridium difficile infection

Nathaniel A. Cohen, Dan M. Livovsky, Shir Yaakobovitch, Merav Ben Yehoyada, Ronen Ben Ami, Amos Adler, Hanan Guzner-Gur, Eran Goldin, Moshe E. Santo, Zamir Halpern, Kalman Paz, Nitsan Maharshak*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Antibiotic treatment of Clostridium difficile infection (CDI) has a high failure rate. Fecal microbiota transplantation (FMT) has proven very effective in treating these recurrences. Objectives: To determine which method of fecal microbiota transplantation (upper or lower gastrointestinal) and which type of donor (a relative or unrelated) is superior. Methods: This is a retrospective analysis of treatment protocols and outcomes in 22 patients with refractory or recurrent CDI who underwent FMT at two Israeli facilities. Each center used a different donor type, stool preparation and method of delivery. The Tel Aviv Sourasky Medical Center used unrelated fecal donors and frozen stool samples and delivered them primarily (92%) via the lower gastrointestinal (GI) tract. Shaare Zedek Medical Center used fresh donor stool of relatives and delivered them primarily (90%) via the upper GI tract. Results: FMT had an overall 2 month cure rate of 89%. Patients treated with FMT that was executed through the lower GI tract recovered faster from the infection (1.6 ± 1.08 vs. 2.4 ± 1 days for the upper tract, P = 0.03). The results also showed that patients who received lower GI tract FMTs were more likely to be cured of CDI (100% vs. 75% for upper tract FMTs, P = 0.16). Five patients (22%) died of CDI/FMT-unrelated causes and two (10%) died of CDI/FMT-related causes during the study period. Conclusions: Lower GI tract FMT is a safe and effective treatment for refractory and recurrent CDI, and yields quicker results than upper GI tract FMT.

Original languageEnglish
Pages (from-to)594-599
Number of pages6
JournalIsrael Medical Association Journal
Volume18
Issue number10
StatePublished - Oct 2016
Externally publishedYes

Keywords

  • Bacteriotherapy
  • Clostridium difficile
  • Colonoscopy
  • Diarrhea
  • Fecal microbiota transplantation (FMT)
  • Gastroscopy

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