Duodenal Infusion of Donor Feces for Recurrent Clostridium difficile

the Laboratory of Microbiology, Wageningen University, Wageningen (S.F., E.G.Z., W.M.V.)
New England Journal of Medicine (Impact Factor: 55.87). 01/2013; 368(5). DOI: 10.1056/NEJMoa1205037
Source: PubMed


Recurrent Clostridium difficile infection is difficult to treat, and failure rates for antibiotic therapy are high. We studied the effect of duodenal infusion of donor feces in patients with recurrent C. difficile infection.

We randomly assigned patients to receive one of three therapies: an initial vancomycin regimen (500 mg orally four times per day for 4 days), followed by bowel lavage and subsequent infusion of a solution of donor feces through a nasoduodenal tube; a standard vancomycin regimen (500 mg orally four times per day for 14 days); or a standard vancomycin regimen with bowel lavage. The primary end point was the resolution of diarrhea associated with C. difficile infection without relapse after 10 weeks.

The study was stopped after an interim analysis. Of 16 patients in the infusion group, 13 (81%) had resolution of C. difficile-associated diarrhea after the first infusion. The 3 remaining patients received a second infusion with feces from a different donor, with resolution in 2 patients. Resolution of C. difficile infection occurred in 4 of 13 patients (31%) receiving vancomycin alone and in 3 of 13 patients (23%) receiving vancomycin with bowel lavage (P<0.001 for both comparisons with the infusion group). No significant differences in adverse events among the three study groups were observed except for mild diarrhea and abdominal cramping in the infusion group on the infusion day. After donor-feces infusion, patients showed increased fecal bacterial diversity, similar to that in healthy donors, with an increase in Bacteroidetes species and clostridium clusters IV and XIVa and a decrease in Proteobacteria species.

The infusion of donor feces was significantly more effective for the treatment of recurrent C. difficile infection than the use of vancomycin. (Funded by the Netherlands Organization for Health Research and Development and the Netherlands Organization for Scientific Research; Netherlands Trial Register number, NTR1177.).


Available from: Susana Fuentes, Jan 24, 2014
  • Source
    • "Recent meta-analysis on CDI treatment successes (Johnston et al., 2012) in faecal transplantation in CDI therapy (Brandt, 2012; Van Nood et al., 2013) and this case series shows that even in patients at high risk, with multiple severe underlying diseases, administration of multistrain probiotics might be beneficial by shortening the diseases course as well as by preventing further relapses in patients with recurrent CDI. "
    [Show description] [Hide description]
    DESCRIPTION: Probiotics in Clostridium difficile infection: reviewing the need for a multistrain probiotic
  • Source
    • "FMT is an effective and safe treatment for recurrent Clostridium difficile infection (CDI), which develops typically as an antibioticassociated diarrhea [96] [97]. In CDI, FMT restores the diversity and composition of the disrupted, dysbiotic intestinal microbiota and subsequently suppresses the pathogen [97] [98] [99]. In IBD, the few case reports on the successful treatment of the disease by FMT suggest that restoration of the normal, regulatory immune effects of microbiota can be achieved [100] [101]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Abstract Inflammatory bowel diseases (IBDs) are chronic debilitating disorders of unknown etiology, consisting of two main conditions, ulcerative colitis and Crohn's disease. Major advances have recently taken place in human genetic studies of IBD and over 160 risk loci for these two diseases have been uncovered. These genetic data highlight a key role for genes that code for immunological and epithelial barrier functions. Environmental factors also make substantial contributions to the pathogenesis of IBD and account for the growing incidence of the diseases around the world. Intestinal microbiota creates resistance to infection, provides nutrients, and educates the immune system and in many ways has a significant impact on human health. Aberrant microbiota composition and decreased diversity (dysbiotic microbiota) are key etiopathological events in IBD. Dysbiotic microbiota can lead to loss of normal, regulatory immune effects in the gut mucosa. This may play a central role in the development and perpetuation of chronic inflammation. Further, the expression of specific innate immune receptors that recognize microbes is altered in the IBD epithelium. Therefore, the combination of host side epithelial barrier functions and the presence of dysbiotic microbiota in the gut together promote inflammation. New therapeutic options targeting microbiota are currently considered for IBD and they may, in the future, provide means to reverse the pathogenic host-microbiota relationship into a symbiotic one. In this review, the focus is on the intestinal microbiota and host-microbe interactions in IBD.
    Scandinavian Journal of Gastroenterology 01/2015; 50(1):34-42. DOI:10.3109/00365521.2014.966320 · 2.36 Impact Factor
  • Source
    • "P. Bourlioux et al. ne pas y procéder serait non éthique, compte tenu de l'impuissance des antibiothérapies dans ce cas [29]. Le transfert de microbiote à visée thérapeutique marque ainsi une évolution profonde de la pensée, compte tenu de sa nouveauté conceptuelle, méthodologique, et l'on peut bien dire culturelle, du fait du siège intestinal de cette symbiose. "
    [Show abstract] [Hide abstract]
    ABSTRACT: (PAPER IN FRENCH) The gut microbiota (or gut flora) is a set of bacteria living in symbiosis with the host. Strictly associated with the intestinal tract and interacting with it, the gut microbiota is not a tissue nor an organ, but a supra-organism. A disruption of dialogue between bacteria and human cells is a risk factor or a possible cause of various diseases. The restoration of this dialogue, thanks to the transfer of the gut microbiota of a healthy individual to a patient whose balance of gut flora has been broken, is a new therapeutic approach. If its exact effect still eludes scientific understanding, its clinical benefit is well established for an indication, and is recently being tested for many others. The proven contribution of gut microbiota in the human physiological balance calls for intensifying research throughout the world about the state of knowledge and technologies, as well as on the legal and ethical dimension of fecal microbiota transfer. This didactic paper updates the questions in relation with this therapeutic act.
    Annales Pharmaceutiques Françaises 09/2014; 72(5):325-9.
Show more