Lyophilised Full Spectrum Microbiota Capsules for Treatment of Severe Clostridium difficile Infection in 2 Patients in ICU: A Case Study

Abstract

Clostridium difficile infection (CDI) is the most common cause of pseudomembranous colitis and in extreme cases may also result in death. CDI symptoms range in severity from loose stools to severe bloody diarrhoea in conjunction with colonic ulceration and life threatening peritonitis. Encapsulated Lyophilized Fecal Microbiota Transplantation (LFMT) for the treatment of severe CDI has not been used before and we report two such cases admitted to Australian Intensive Care Units (ICU). Patient A: Male patient, age 79 years, diagnosed with CDI Colitis in December 2017 with elevated inflammatory markers, white cell count (WCC) 60, C-reactive protein (CRP) 380. The patient was treated with metronidazole and oral vancomycin. In January 2018, he experienced severe diarrhoea with associated left side abdominal pain and was admitted to ICU for septic shock with presumed pseudomembranous colitis. He was administered 80 LFMT capsules over 7 days. The patient's inflammatory markers were reduced (WCC 14, CRP 105), however abdominal pain and distension continued. Bowel motions improved to formed stool. Stool test for culture and polymerase chain reaction (PCR) for C. difficile toxin was negative. The Patient was able to leave ICU. He later died of unrelated respiratory disease. Patient B: Male patient, age 68 years, was admitted into ICU for non-gastrointestinal related symptoms and developed abdominal distension, bowel dilatation and thickening. He also experienced left sided abdominal tenderness, pain and loose bowel motions. The patient was diagnosed with pseudo-obstruction and CDI colitis. Inflammatory markers were high (WCC 20, CRP 65). He commenced on oral metronidazole and vancomycin followed by 36 LFMT capsules administered over 3 days via nasogastric tube. His bowel motions and abdominal tenderness improved and WCC was reduced to 9. Stool test for culture and PCR for C. difficile toxin was negative. The patient was able to leave ICU but died later due to respiratory illness. Treatment with encapsulated LFMT can eradicate CDI and improve symptoms in patients suffering from severe CDI colitis. More studies are required to examine the efficacy and route of delivery in ICU of FMT for severe CDI.