title: Intestinal microbiota transplantation, a simple and effective treatment for severe and refractory Clostridium difficile infection.
abstract: BACKGROUND
  Restoring normal fecal flora through intestinal microbiota transplantation (IMT) was successful in curing recurrent Clostridium difficile infection (CDI). However, only a few cases have been reported of IMT being utilized for the treatment of severe or fulminant CDI.
  
  
  OBJECTIVE
  Is IMT a simple and effective treatment for severe and recurrent CDI?
  
  
  METHODS
  In this retrospective study, we report 14 patients with severe CDI refractory to conventional medical therapy, who underwent IMT. Fresh donor stool specimen was manually homogenized with warm tap water, filtered through gauze and then instilled through nasogastric tube (NGT). The primary outcome was clinical cure, defined as less than 3 loose bowel movements a day on day 7 after IMT and no need for further CDI therapy. The secondary outcomes were recurrence of CDI within 100 days of IMT and 30-day mortality after IMT. Descriptive statistics were done.
  
  
  RESULTS
  Fourteen patients with severe and refractory CDI received IMT. Mean age was 73.4 ± 11.9 years (range 52-92). IMT was given via NGT in 13 of the 14 patients. Eleven patients (79 %) achieved cure after IMT. No recurrence was seen in the patients who responded to IMT and were alive within the 100 day follow-up period. IMT was well tolerated. The 30-day all-cause mortality was 29 %, all 4 patients died as a result of their underlying cancer. No patients died as a result of CDI or IMT.
  
  
  CONCLUSIONS
  IMT performed at the bedside via NGT is effective and safe for the treatment of severe and refractory CDI, and prevents recurrence.
authors: Department of Infectious Diseases, Henry Ford Health System, Detroit, MI, USA.
authors: Hadeel
authors: H
authors: Zainah
authors: Mona
authors: M
authors: Hassan
authors: Laila
authors: L
authors: Shiekh-Sroujieh
authors: Syed
authors: S
authors: Hassan
authors: George
authors: G
authors: Alangaden
authors: Mayur
authors: M
authors: Ramesh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001691:Biological Therapy / Q000379:methods*; D016360:Clostridioides difficile; D003113:Colonoscopy; D004761:Enterocolitis, Pseudomembranous / Q000628:therapy*; D005243:Feces / Q000382:microbiology*; D005260:Female; D006801:Humans; D007422:Intestines / Q000382:microbiology*; D007441:Intubation, Gastrointestinal; D008297:Male; D064307:Microbiota; D012008:Recurrence; D012189:Retrospective Studies