Faecal microbiota transplantation plus selected use of vancomycin for severe‐complicated Clostridium difficile infection: description of a protocol with high success rate

Summary Background Severe and severe/complicated Clostridium difficile infection (CDI) can result in ICU admission, sepsis, toxic megacolon and death. In this setting, colectomy is the standard of care but it is associated with a 50% mortality. Aim To evaluate safety and efficacy of a sequential fae...

Full description

Saved in:

Bibliographic Details
Published in:	Alimentary pharmacology & therapeutics 2015-08, Vol.42 (4), p.470-476
Main Authors:	Fischer, M., Sipe, B. W., Rogers, N. A., Cook, G. K., Robb, B. W., Vuppalanchi, R., Rex, D. K.
Format:	Article
Language:	eng
Subjects:	Adult Aged Aged, 80 and over Anti-Bacterial Agents - therapeutic use Clostridium difficile - isolation & purification Clostridium Infections - drug therapy Colectomy Colonoscopy - methods Fecal Microbiota Transplantation - methods Female Humans Male Metronidazole - therapeutic use Middle Aged Retrospective Studies Sepsis - epidemiology Shock, Septic - epidemiology Vancomycin - therapeutic use
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	Summary Background Severe and severe/complicated Clostridium difficile infection (CDI) can result in ICU admission, sepsis, toxic megacolon and death. In this setting, colectomy is the standard of care but it is associated with a 50% mortality. Aim To evaluate safety and efficacy of a sequential faecal microbiota transplantation (FMT) and antibiotic protocol in severe and severe/complicated CDI patients who are at high risk for colectomy. Methods All patients with severe and severe/complicated CDI refractory to oral vancomycin ± rectal vancomycin and intravenous metronidazole therapy were offered FMT. Treatment consisted of sequential FMTs via colonoscopy with the need for repeat FMT and continued vancomycin guided by clinical response and pseudomembranes at colonoscopy. Results A total of 29 patients underwent FMT between July 2013 and August 2014. The overall treatment response of endoscopic sequential FMT was 93% (27/29), with 100% (10/10) for severe CDI and 89% (17/19) for severe/complicated CDI. A single FMT was performed in 62%, two FMTs were performed in 31% and three FMTs in 7% of patients. The use of non‐CDI antibiotics predicted repeat FMT (odds ratio = 17.5). The 30‐day all‐cause mortality after FMT was 7%, and the cumulative 3‐month survival was 76%. Of the two patients who died within 30 days, one underwent colectomy and succumbed to sepsis; the other died from septic shock related to CDI. Conclusion The success of a treatment protocol for severe and severe/complicated involving faecal microbiota transplantation and continued vancomycin in selected patients was high, and it warrants further evaluation.
ISSN:	0269-2813 1365-2036