title: Faecal microbiota transplantation and bacteriotherapy for recurrent Clostridium difficile infection: a retrospective evaluation of 31 patients.
abstract: BACKGROUND
  Recurrent Clostridium difficile infection (CDI) is a significant problem due to its increased incidence and severity. Failure rates for standard antibiotic therapies are high. In our hospital, faecal microbiota transplantation (FMT), or instillation of a culture mixture of known enteric bacteria in saline as rectal bacteriotherapy (RBT), has long been used as 'rescue therapy' in patients with recurrent disease, in whom repeated courses of standard antibiotic treatment have failed. We wanted to evaluate the effectiveness of FMT and RBT for recurrent CDI.
  
  
  METHODS
  The records of 31 patients treated with either FMT or RBT for recurrent CDI were reviewed retrospectively. FMT was based on faecal donation by a close relative and RBT on a defined saline mixture of 10 individually cultured enteric bacterial strains originally isolated from healthy persons. Both types of instillation were carried out through a rectal catheter. FMT (500 ml) was given as 1 installation. RBT (200 ml) was given as 2 or 3 installations with an interval of 2 days between courses. Treatment success was defined as a sustained loss of symptoms and discontinuation of diarrhoea within 3 days.
  
  
  RESULTS
  Of 31 patients, 23 (74%) responded successfully to the treatment: 16 of 23 (70%) receiving FMT and 7 of 8 (88%) receiving RBT.
  
  
  CONCLUSIONS
  We found FMT to be effective in patients with recurrent CDI. RBT based on a predefined bacterial suspension was as effective as or better than FMT based on faecal donation; however, multiple installations may be needed.
authors.affiliation: From the Department of Internal Medicine , Skaraborgs Hospital Skövde , Sweden.
authors.forename: Frida
authors.initials: F
authors.lastname: Emanuelsson
authors.forename: Berndt E B
authors.initials: BE
authors.lastname: Claesson
authors.forename: Lars
authors.initials: L
authors.lastname: Ljungström
authors.forename: Michael
authors.initials: M
authors.lastname: Tvede
authors.forename: Kjell-Arne
authors.initials: KA
authors.lastname: Ung
mesh_terms: D000328:Adult; D000368:Aged; D001691:Biological Therapy / Q000379:methods*; D003015:Clostridium Infections / Q000628:therapy*; D005243:Feces / Q000382:microbiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055502:Secondary Prevention; D016896:Treatment Outcome