Treatment of Refractory/Recurrent C. difficile-associated Disease by Donated Stool Transplanted Via Colonoscopy

Abstract

Purpose and Objective Over the past 20 years, Clostridium difficile has emerged as an important microbial cause of nosocomial diarrhea. Recurrence is common and management of recurrent disease is not standardized. In this case series, we describe 12 patients with refractory/recurrent C. difficile-associated disease (CDAD) treated at our institution by transplantation of donated stool via colonoscopy. Methods This is a retrospective study of 12 consecutive patients with refractory/recurrent C. difficile infection evidenced by recurrent symptoms and a history of a positive fecal C. difficile toxin assay that were treated by transplantation of donated stool administered during colonoscopy. Results Our cohort comprised 9 women and 3 men with a mean age of 66 years (range 30 to 86 y). Nine of the 12 patients had diverticulosis. Patients were symptomatically ill for 79 to 1532 days (mean 351 d, median 209 d) before fecal transplantation. The index infection for which antibiotics was prescribed varied widely along with the inciting antibiotic. All 12 patients (100%) experienced an immediate and durable clinical response to fecal transplantation. There were no adverse side effects from fecal transplantation. Conclusions Fecal transplantation via colonoscopy is a safe, effective treatment regimen for refractory/recurrent CDAD. Our 12 patients had an immediate and durable response rate of 100%. Fecal transplantation is a promising treatment for refractory/recurrent C. difficile infection. Its use and efficacy should be pursued in prospective controlled trials.