Fecal Transplant: An Up-and-Coming Cure for Recurrent C. diff

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The Journal of Clinical Gastroenterology reported on a study that involved 19 patients who underwent fecal transplant. Out of 19 patients, 18 initially responded to treatment after a single round of fecal transplant, and one patient responded after a second fecal transplant infusion. All 19 patients’ maintained prolonged cured status followed until submission, ranging from six months to five years. Three patients were presumed reinfected after remaining symptom free for a period spanning six months to four years. These patients tested positive for C. difficile after prescription of additional antibiotics for unrelated infections.8

Grehan et al published another study that aimed to show beneficial change in the patients’ bacterial population of the colon to represent those of the healthy donor’s microbiota post fecal transplant. This study involved 10 patients who underwent fecal transplant. The bacterial populations in their fecal samples were followed from pretreatment to 24 weeks post initial infusion and compared with the initial infused donor fecal suspension. Results showed that at four, eight, and 24 weeks after the procedure, the bacterial populations in the patients’ fecal samples consisted predominantly of bacteria derived from the healthy donor samples. Additionally, comparisons of similarity for samples of four, eight, and 24 weeks to the donor-infused sample were made and each recipient’s baseline sample was statistically significant. 

Additionally, Dr. Brandt and Dr. Yoon reported on 12 patients with refractory/recurrent C. difficile infection who were successfully treated at Montefiore Medical Center with fecal transplant. Prior to fecal transplant, these patients were reportedly ill for 79─1,532 days despite multiple courses of antibiotics to treat their symptoms. Post fecal transplant, all 12 patients experienced an immediate and durable response up to five years later with no reported adverse effects.9

Clinicians see the importance of these reports as proof that the donor-stool microbiota can survive for a significant period of time in the recipient. Therefore, it may be helpful in the treatment of recurrent C. difficile.

Even though several studies have reported promising results from fecal bacteriotherapy, the use of this method for treatment of recurrent C. difficile infection remains scarce. Additionally, very few of these studies report in any detail on the specific methodology used during the procedure. In addition to concerns of safety and acceptability, lacking is an established standardized regimen for this type of therapy. The review of literature documented various methods of instillation and preparation of fecal suspension, inconsistent donor screening, recipient and donor post-transplant testing, and outcomes.

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