Combined Jejunal and Colonic Fecal Bacteriotherapy in Patients with Recurrent Clostridium Difficile Infection (RCDI)

Abstract

Purpose: Recent epidemiological trends suggest an increase in frequency of Recurrent Clostridium Difficile infection (RCDI) in the United States (5-35% per Emerging Infectious Diseases 2008; 14: 929-31). RCDI is generally treated with additional courses of various antibiotics. However, subsets of patients continue to suffer from persistent abdominal pain, diarrhea and Clostridium Difficile infection. Fecal instillations from healthy donors have been administered through enemas and nasogastric tube with significant clinical efficacy. A large number of patients, however, have concerns about regurgitation and lack of retention of fecal instillation from healthy donors. To overcome this problem, we have administered fecal bacteriotherapy from healthy donors to jejunum and colon of 3 patients with RCDI. Methods: The study subjects were three women (ages 85, 53 and 31 yrs) with RCDI for >6-months, and >5 recurrences. Patients had received all standard RCDI treatments, including the 2010 guideline recommendations from the Infectious Diseases Society of America (IDSA), but still had persistent crampy abdominal pain, chronic diarrhea and weight-loss. On colonoscopy, the severity of disease ranged from severe left-sided colitis in one-case to mild right-sided colitis in the other two. Fecal samples from healthy donors were collected, homogenized, liquefied, and processed in the microbiology lab. Varying amounts of fecal instillations were administered to RCDI patients during colonoscopy and enteroscopy. Results: Outcome: all three patients had complete resolution of symptoms within a few days after administration of fecal bacteriotherapy. Follow-up: all three patients have been symptom-free and off antibiotics for the last 3-22 weeks. Conclusion: These observations suggest fecal bacteriotherapy administered in the jejunum and colon is a highly effective treatment option in RCDI patients. Combined jejunal and colonic instillation of fecal bacteriotherapy achieves prompt resolution of RCDI symptoms. Additional controlled trials are required for further validation of this therapy.