title: [Treatment of recurrent Clostridium difficile-associated diarrhoea with a suspension of donor faeces].
abstract: OBJECTIVE
  To study the effect of treating recurrent Clostridium difficile-associated diarrhoea (CDAD) with a suspension of donor faeces.
  
  
  METHODS
  Uncontrolled interventional study.
  
  
  METHODS
  Patients that, despite adequate antibiotic therapy, had developed at least 2 recurrences ofCDAD, including at least one recurrence that had been treated with a vancomycin tapering regimen, were included in the study. Relatives or volunteers served as faeces donor. All donors were previously examined for the presence of HIV, hepatitis B- and C-virus, and acute infection with cytomegalovirus or Epstein-Barr virus. The donor faeces were examined for the presence of C. difficile, Yersinia, Campylobacter, Shigella, Salmonella, and parasites. Before the infusion of donor faeces, the patients were treated for 4 days with vancomycin 500 mg q.i.d., followed by colon lavage. The suspension of 150 g of donor faeces dissolved in 300-400 ml of NaCl was infused into the jejunum via a duodenal catheter or into the caecum via colonoscopy.
  
  
  RESULTS
  7 CDAD patients were included and treated, including 2 with the hypervirulent C. difficile-strain PCR ribotype 027, toxinotype III. In 5 patients, the defaecation frequency returned to normal almost immediately after treatment and the cultures and toxin tests for C. difficile were repeatedly negative. In the remaining 2 patients, the treatment was successful after a repeated infusion of faeces from a different donor.
  
  
  CONCLUSIONS
  Treatment with donor faeces seems promising for patients who develop repeated recurrences despite adequate therapy and could be valuable in the future during (local) epidemics of the PCR ribotype 027 strain. A randomised nationwide study (FECAL trial) has been started in order to determine the efficacy of this treatment.
authors.affiliation: Academisch Medisch Centrum/Universiteit van Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam.
authors.forename: M
authors.initials: M
authors.lastname: Nieuwdorp
authors.forename: E
authors.initials: E
authors.lastname: van Nood
authors.forename: P
authors.initials: P
authors.lastname: Speelman
authors.forename: H A
authors.initials: HA
authors.lastname: van Heukelem
authors.forename: J M
authors.initials: JM
authors.lastname: Jansen
authors.forename: C E
authors.initials: CE
authors.lastname: Visser
authors.forename: E J
authors.initials: EJ
authors.lastname: Kuijper
authors.forename: J F W M
authors.initials: JF
authors.lastname: Bartelsman
authors.forename: J J
authors.initials: JJ
authors.lastname: Keller
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016360:Clostridioides difficile / Q000254:growth & development; D003015:Clostridium Infections / Q000382:microbiology / Q000517:prevention & control*; D003967:Diarrhea / Q000382:microbiology / Q000517:prevention & control*; D004761:Enterocolitis, Pseudomembranous / Q000517:prevention & control; D005243:Feces / Q000382:microbiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D016896:Treatment Outcome; D014640:Vancomycin / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin