Book chapter
Duodenal Infusion of Donor Feces for Recurrent Clostridium Difficile
i50 Landmark Papers, pp 91-92
2020
Abstract
Background
Recurrent Clostridium difficile infection is difficult to treat, and failure rates for antibiotic therapy are high. We studied the effect of duodenal infusion of donor feces in patients with recurrent C. difficile infection.
Methods
We randomly assigned patients to receive one of three therapies: an initial vancomycin regimen (500 mg orally four times per day for 4 days) followed by bowel lavage and subsequent infusion of a solution of donor feces through a nasoduodenal tube, a standard vancomycin regimen (500 mg orally four times per day for 14 days), or a standard vancomycin regimen with bowel lavage. The primary endpoint was the resolution of diarrhea associated with C. difficile infection without relapse after 10 weeks.
Results
The study was stopped after an interim analysis. Of 16 patients in the infusion group, 13 (81%) had resolution of C. difficile-associated diarrhea after the first infusion. The three remaining patients received a second infusion with feces from a different donor, with resolution in two patients. Resolution of C. difficile infection occurred in 4 of 13 patients (31%) receiving vancomycin alone and in 3 of 13 patients (23%) receiving vancomycin with bowel lavage (P < 0.001 for both comparisons with the infusion group). No significant differences in adverse events among the three study groups were observed except for mild diarrhea and abdominal cramping in the infusion group on the infusion day. After donor-feces infusion, patients showed increased fecal bacterial diversity, similar to that in healthy donors, with an increase in Bacteroides species and Clostridium clusters IV and XIVa, and a decrease in Proteobacteria species.
Conclusions
The infusion of donor feces was significantly more effective for the treatment of recurrent C. difficile infection than the use of vancomycin. (Funded by the Netherlands Organization for Health Research and Development and the Netherlands Organization for Scientific Research; Netherlands Trial Register number, NTR1177.)
Recurrent Clostridium difficile infection is difficult to treat, and failure rates for antibiotic therapy are high. This chapter discusses the effect of duodenal infusion of donor feces in patients with recurrent C. difficile infection. Resolution of C. difficile infection occurred in 4 of 13 patients receiving vancomycin alone and in 3 of 13 patients receiving vancomycin with bowel lavage. After donor-feces infusion, patients showed increased fecal bacterial diversity, similar to that in healthy donors, with an increase in Bacteroides species and Clostridium clusters IV and XIVa, and a decrease in Proteobacteria species. The infusion of donor feces was significantly more effective for the treatment of recurrent C. difficile infection than the use of vancomycin. The chapter demonstrates the superiority of infusing donor feces into the gastrointestinal tract over antibiotic management. The logistics of infusing relatively large amounts of fresh donor feces has been shown to be manageable.
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Details
- Title
- Duodenal Infusion of Donor Feces for Recurrent Clostridium Difficile
- Creators
- Sarah MathewJessica BartonAdrian W. Ong
- Contributors
- Stephen M. Cohn (Editor)Peter Rhee (Editor)
- Publication Details
- i50 Landmark Papers, pp 91-92
- Publisher
- CRC Press
- Edition
- 1
- Resource Type
- Book chapter
- Language
- English
- Academic Unit
- Surgery
- Other Identifier
- 991022020734804721