title: The outcome and long-term follow-up of 94 patients with recurrent and refractory Clostridium difficile infection using single to multiple fecal microbiota transplantation via retention enema.
abstract: Clostridium difficile infection (CDI) is one of the most frequent causes of healthcare-associated infections, and its rates are also increasing in the community. The management of CDI has become a major challenge, given growing rates of recurrences and failures with standard antibiotic therapy. Mounting evidence suggests that fecal microbiota transplantation (FMT) may be effective; however, as there is a paucity of data with regard to repeat FMT for primary non-response to this treatment, this study examined the outcome of multiple FMTs for recurrent CDI. Case records were reviewed for 94 patients who underwent FMT via retention enema for recurrent or refractory CDI during the period 2008-2012. Demographic information, treatment data, and clinical resolution rates were examined for single FMT and cumulative resolution was assessed for multiple FMTs in the context of ongoing symptoms. The cumulative clinical resolution following four or more FMTs was 86%. When antibiotic therapy was used between FMTs, the clinical resolution rate increased to 92%. There were no reported adverse events and no patients who were cured with FMT had further episodes of CDI at 6-24 months follow-up. Multiple FMTs administered through enemas is an effective, safe, and simple therapy for the management of recurrent or refractory CDI.
authors.affiliation: Department of Pathology and Molecular Medicine, McMaster University, St Joseph's Healthcare, 50 Charlton Avenue East, 424 Luke Wing, Hamilton, ON, L8N 4A6, Canada, clee@mcmaster.ca.
authors.forename: C H
authors.initials: CH
authors.lastname: Lee
authors.forename: J E
authors.initials: JE
authors.lastname: Belanger
authors.forename: Z
authors.initials: Z
authors.lastname: Kassam
authors.forename: M
authors.initials: M
authors.lastname: Smieja
authors.forename: D
authors.initials: D
authors.lastname: Higgins
authors.forename: G
authors.initials: G
authors.lastname: Broukhanski
authors.forename: P T
authors.initials: PT
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D016360:Clostridioides difficile / Q000187:drug effects*; D003015:Clostridium Infections / Q000382:microbiology / Q000628:therapy*; D003428:Cross Infection / Q000382:microbiology / Q000628:therapy*; D024881:Drug Resistance, Bacterial; D004733:Enema; D005243:Feces / Q000382:microbiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D064307:Microbiota; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents