title: Fecal microbiota transplant in severe and severe-complicated Clostridium difficile: A promising treatment approach.
abstract: Severe and severe-complicated Clostridium difficile infection (CDI) is associated with high morbidity and mortality. Colectomy is standard of care; however, post-surgical mortality rates approach 50%. Case reports suggest fecal microbiota transplant (FMT) is a promising treatment of severe and severe-complicated disease but there is a paucity of data. Here, we present a single center experience with a novel sequential FMT protocol for patients refractory to maximal medical therapy. This approach consists of at least one FMT delivered via colonoscopy with criteria for repeat FMT and continued vancomycin therapy based on clinical response and pseudomembranes. Our cohort included 57 consecutive inpatients diagnosed with severe or severe-complicated CDI and treated with FMT. Overall, 91% (52/57) experienced clinical cure at 1 month with a 100% cure rate among severe CDI (n = 19) patients and an 87% cure rate for severe-complicated CDI (n = 33) patients. For the cohort, the survival rate was 94.7% at 1 month and 78.6% at 3 months. There were no serious adverse events related to FMT including no procedure-related complications or perforation. There was no difference in outcome between fresh or frozen fecal material. Sequential FMT for inpatients with severe or severe-complicated CDI is promising and may be preferred over colectomy in certain patients.
authors.affiliation: a Division of Gastroenterology and Hepatology , Indiana University , Indianapolis , IN , USA.
authors.forename: Monika
authors.initials: M
authors.lastname: Fischer
authors.affiliation: b Private Practice , Indianapolis , IN , USA.
authors.forename: Brian
authors.identifier: 0000-0001-7789-9331
authors.initials: B
authors.lastname: Sipe
authors.affiliation: a Division of Gastroenterology and Hepatology , Indiana University , Indianapolis , IN , USA.
authors.forename: Yao-Wen
authors.identifier: 0000-0002-6256-5686
authors.initials: YW
authors.lastname: Cheng
authors.affiliation: a Division of Gastroenterology and Hepatology , Indiana University , Indianapolis , IN , USA.
authors.forename: Emmalee
authors.initials: E
authors.lastname: Phelps
authors.affiliation: a Division of Gastroenterology and Hepatology , Indiana University , Indianapolis , IN , USA.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Rogers
authors.affiliation: a Division of Gastroenterology and Hepatology , Indiana University , Indianapolis , IN , USA.
authors.forename: Sashidhar
authors.initials: S
authors.lastname: Sagi
authors.affiliation: a Division of Gastroenterology and Hepatology , Indiana University , Indianapolis , IN , USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Bohm
authors.affiliation: c Department of Biostatistics, The Richard M. Fairbanks School of Public Health and School of Medicine , Indiana University , Indianapolis , IN , USA.
authors.forename: Huiping
authors.initials: H
authors.lastname: Xu
authors.affiliation: d OpenBiome , Somerville , MA , USA.|e Division of Biological Engineering , Massachusetts Institute of Technology , Cambridge , MA , USA.
authors.forename: Zain
authors.initials: Z
authors.lastname: Kassam
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003015:Clostridium Infections / Q000628:therapy*; D015331:Cohort Studies; D003082:Colectomy; D003113:Colonoscopy; D000069467:Fecal Microbiota Transplantation; D005243:Feces / Q000382:microbiology; D005260:Female; D005500:Follow-Up Studies; D005615:Freezing; D000069196:Gastrointestinal Microbiome; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome; D014640:Vancomycin / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin
keywords: FMT; Fecal microbiota transplant; fulminant C. difficile; pseudomembranes; severe C. difficile infection; severe and complicated C. difficile infection