title: Fecal transplantation, through colonoscopy, is effective therapy for recurrent Clostridium difficile infection.
abstract: OBJECTIVE
  Treatment of recurrent Clostridium difficile infection (CDI) with antibiotics leads to recurrences in up to 50% of patients. We investigated the efficacy of fecal transplantation in treatment of recurrent CDI.
  
  
  METHODS
  We reviewed records from 70 patients with recurrent CDI who had undergone fecal transplantation. Fecal transplantation was performed at colonoscopy by infusing fresh donor feces into cecum. Before transplantation, the patients had whole-bowel lavage with polyethylene glycol solution. Clinical failure was defined as persistent or recurrent symptoms and signs, and a need for new therapy.
  
  
  RESULTS
  During the first 12 weeks after fecal transplantation, symptoms resolved in all patients who did not have strain 027 C difficile infections. Of 36 patients with 027 C difficile infection, 32 (89%) had a favorable response; all 4 nonresponders had a pre-existing serious condition, caused by a long-lasting diarrheal disease or comorbidity and subsequently died of colitis. During the first year after transplantation, 4 patients with an initial favorable response had a relapse after receiving antibiotics for unrelated causes; 2 were treated successfully with another fecal transplantation and 2 with antibiotics for CDI. Ten patients died of unrelated illnesses within 1 year after transplantation. No immediate complications of fecal transplantation were observed.
  
  
  CONCLUSIONS
  Fecal transplantation through colonoscopy seems to be an effective treatment for recurrent CDI and also for recurrent CDI caused by the virulent C difficile 027 strain.
authors.affiliation: Department of Infectious Diseases, Helsinki University Central Hospital, Helsinki, Finland. eero.mattila@hus.fi
authors.forename: Eero
authors.initials: E
authors.lastname: Mattila
authors.forename: Raija
authors.initials: R
authors.lastname: Uusitalo-Seppälä
authors.forename: Maarit
authors.initials: M
authors.lastname: Wuorela
authors.forename: Laura
authors.initials: L
authors.lastname: Lehtola
authors.forename: Heimo
authors.initials: H
authors.lastname: Nurmi
authors.forename: Matti
authors.initials: M
authors.lastname: Ristikankare
authors.forename: Veikko
authors.initials: V
authors.lastname: Moilanen
authors.forename: Kimmo
authors.initials: K
authors.lastname: Salminen
authors.forename: Maaria
authors.initials: M
authors.lastname: Seppälä
authors.forename: Petri S
authors.initials: PS
authors.lastname: Mattila
authors.forename: Veli-Jukka
authors.initials: VJ
authors.lastname: Anttila
authors.forename: Perttu
authors.initials: P
authors.lastname: Arkkila
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016360:Clostridioides difficile / Q000472:pathogenicity*; D003113:Colonoscopy / Q000009:adverse effects / Q000401:mortality; D004761:Enterocolitis, Pseudomembranous / Q000382:microbiology / Q000401:mortality / Q000628:therapy*; D005243:Feces / Q000382:microbiology*; D005260:Female; D005387:Finland; D006801:Humans; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000008:administration & dosage; D012008:Recurrence; D012189:Retrospective Studies; D007507:Therapeutic Irrigation; D013997:Time Factors; D016896:Treatment Outcome; D014774:Virulence; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D011092:Polyethylene Glycols