title: Duodenal infusion of donor feces for recurrent Clostridium difficile.
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 end point 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 3 remaining patients received a second infusion with feces from a different donor, with resolution in 2 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 Bacteroidetes 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.).
authors: Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors: Els
authors: E
authors: van Nood
authors: Anne
authors: A
authors: Vrieze
authors: Max
authors: M
authors: Nieuwdorp
authors: Susana
authors: S
authors: Fuentes
authors: Erwin G
authors: EG
authors: Zoetendal
authors: Willem M
authors: WM
authors: de Vos
authors: Caroline E
authors: CE
authors: Visser
authors: Ed J
authors: EJ
authors: Kuijper
authors: Joep F W M
authors: JF
authors: Bartelsman
authors: Jan G P
authors: JG
authors: Tijssen
authors: Peter
authors: P
authors: Speelman
authors: Marcel G W
authors: MG
authors: Dijkgraaf
authors: Josbert J
authors: JJ
authors: Keller
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016360:Clostridioides difficile; D003131:Combined Modality Therapy; D003967:Diarrhea / Q000188:drug therapy / Q000382:microbiology / Q000628:therapy*; D004386:Duodenum; D005243:Feces / Q000382:microbiology*; D005260:Female; D006801:Humans; D007441:Intubation, Gastrointestinal; D008297:Male; D054892:Metagenome; D008875:Middle Aged; D012008:Recurrence; D007507:Therapeutic Irrigation; D014640:Vancomycin / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin