10/14/2015

DonorFecalInfusionforRecurrentClostridium
difficileInfection
JosephT.DiPiro,ExecutiveDeanandProfessor,SouthCarolinaCollegeofPharmacy,UniversityofSouth
Carolina,ColumbiaandMedicalUniversityofSouthCarolina,Charleston

Topic:ArecentstudysupportstheuseofinfusionofdonorfecesforrecurrentC.difficileinfection.1
Background:C.difficileinfectionhasbeenapersistentproblem,commonlyafterantimicrobialusage.Itisthe
mostcommoncauseofinfectiousdiarrheainhospitalizedpatients.2Theincidenceandseverityofthedisease
haveincreaseddramaticallysince2000.2Whilemostcasesareresolvedwithdiscontinuationofthe
antimicrobialandtreatmentwithoralvancomycinormetronidazole,relapseafterantimicrobialtreatment
occursinapproximately20%ofinfectedpatients.Theoptimalmanagementofpatientswithmultiplerelapses
hasnotbeenclear.Manydifferentantimicrobialsaloneorincombinationhavebeentriedwithinconsistent
success.
NewInformation:Adefinitivestudyhasbeenpublisheddemonstratingthatduodenalinfusionofdonorfeces
wasmoreeffectivethanvancomycinfortreatmentofrecurrentC.difficileinfection.PatientswithrecurrentC.
difficileinfectionwererandomizedtoreceivevancomycin500mgorallyfourtimesperdayfor14days,a
vancomycinregimenwithbowellavage,orvancomycin500mgorallyfourtimesperdayfor4daysfollowed
bybowellavagethenaninfusionofasolutionofdonorfecesthroughanasoduodenaltube.Thirteenof16
patients(81%)whoreceivedthefecalinfusionhadresolutionoftheC.difficileassociateddiarrheaafterthe
firstinfusion.Resolutionoccurredin4of13patients(31%)givenvancomycinaloneand3of13patients
(23%)givenvancomycinwithbowellavage.Adverseeventswerenotsignificantlydifferentamongthe
groups.Thefecalinfusiongroupexperiencedmilddiarrheaandabdominalcrampingonthedayofinfusion.
InterpretationandApplication:Infusionofdonorfeceswasconcludedtobesignificantlymoreeffectivefor
treatmentofrecurrentC.difficileinfectionthanuseofvancomycin.Thistrialprovidesstrongevidencefor
usingfecalinfusionforpatientswithrecurrentinfection.Thismethodwasdescribedmanyyearsago,but
adequatecontrolledtrialshadnotbeenconductedtoconclusivelydemonstrateeffectivenessoffecal
transfusions.Giventhehistoryoffailuresofmanyotherregimens,includingantimicrobials,fecalinfusion
mayproveanimportantadvanceintreatmentofpatientswithrecurrentC.difficileinfection.
1.NoodEV,VriezeA,NieuwdorpM,etal.DuodenalinfusionofdonorfecesforrecurrentClostridium
difficile.NEnglJMed.2013368:407415.[PubMed:23323867]
2.MartinS,JungR.Gastrointestinalinfectionsandenterotoxigenicpoisonings.In:DiPiroJT,TalbertRL,Yee
GC,MatzkeGR,WellsBG,PoseyLM,eds.Pharmacotherapy:APathophysiologicApproach,8thed.New
York:McGrawHill,2011.
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