SAN DIEGO – Evidence continues to pile up for fecal transplantation in C. difficile infection, with another single-center study reporting high “cure” rates in infected patients.
A total of 46 out of 49 patients treated with intestinal microbiota transplant, or IMT, were quickly rid of their symptoms and had no adverse effects, Mayur Ramesh, MD, of Henry Ford Hospital in Detroit, and colleagues reported at IDWeek 2012 here.
“This treatment is a viable option for patients who are not responding to conventional treatment and who want to avoid surgery,” Ramesh said in a statement.
C. difficile is notoriously hard to treat, with frequent recurrences and lack of response to staples of treatment including metronidazole (Flagyl) and vancomycin (Vancocin). This often results in readmissions, extended hospital stays, and expensive supportive care and infection control measures, the researchers said.
But many clinicians have been turning their attention to fecal transplantation as a means of treating C. difficile infection in recent years, as studies continue to show success with the procedure. And with its rising popularity, researchers have been investigating it in other settings – including as a means of improving metabolic syndrome.
For their study, Ramesh and colleagues treated 49 patients, median age 66, with C. difficile infection at their facility between May 2010 and June 2012. Patients had either moderate and recurrent infection, or severe infection that wasn’t responding to conventional treatment.
The researchers collected fecal material from a healthy family member and tested it for HIV, hepatitis A, B, and C, and syphilis, as well as C. difficile DNA.
About 30 to 50 grams of stool were mixed with warm tap water and filtered through gauze, then delivered to the patient via either naso-gastric tube or colonoscopy.
Most patients were treated in the hospital – 74% received the transplant via naso-gastric tube – while the rest had the procedure in the outpatient setting, with 17% having colonoscopy and 9% having a naso-gastric tube.
The primary outcome was resolution of diarrhea, the main symptom of C. difficile infection, and secondary outcomes included recurrence within 100 days and 30-day mortality.
The researchers found that 46 of the 49 infected patients who were treated recovered quickly – within 1 to 4 days – and had no adverse effects.
The lack of response in three patients was likely due to concurrent antibiotic use in two of those patients and ischemic colitis in the other, the researchers reported.
Only four patients eventually had a recurrence, and the cause of death in the four patients who didn’t survive was unrelated to treatment, they said.
The study was limited by its retrospective, single-center design, and by the possibility of selection bias. Still, they concluded that fecal transplantation “is a simple procedure to prevent recurrence of C. difficile infection and is life-saving in severe [disease].”
They called for further investigation into whether fecal transplantation may serve as a first-line therapy in patients at high risk for recurrence.
Secondary source: Infectious Disease Week: Sroujieh LS, et al “Intestinal microbiota transplantation for Clostridium difficile infection – A single-center experience” IDWeek 2012; Abstract 23.