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

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Rohlke et al. reported on the methodology of a group of 19 patients who underwent fecal transplant.

To summarize this particular study, the preference for donors was first intimate domestic partners, followed by family members and those living in the same household. Exclusionary factors for donors included recent antibiotic use, current or recent diarrheal illness, being a hospital or healthcare worker, and having risky sexual behaviors. Donor stool was screened for C. difficile, enteric pathogens, and some donors were screened serologically for HIV and viral hepatitis.

Donors who reported irregular bowel patterns and could not reliably produce stool the morning of the procedure, received a gentle laxation with small doses of citrate of magnesium.8

Patients receiving fecal transplant were taken off all antibiotic therapy one to three days prior to the procedure. Additionally, patients' colons were prepped with 4L of polyethelyne glycol purge the night prior to the procedure. Donor stool was provided the morning of the procedure and suspended in nonbacteriostatic saline, with manual shaking; other studies reported using a blender to mix the stool.2 The aim was to liquefy the stool adequately to be able to pass through a large 60cc syringe into the colonoscope’s biopsy channel.

The volume was limited to a maximum of 300cc, and was generally in the range of 250cc to 300cc range.8 In this particular study the donated stool was instilled during a colonoscopy, mainly in the right colon. However, other studies have also documented success with fecal transplant administered via enema and nasogastric tube.2

After the procedure, patients were instructed to take immodium immediately and six hours later, in an attempt to diminish colonic motility and maximize contact time with the infused stool. In addition, recipients were instructed to remain on bed rest for several hours post procedure, reintroduce oral food slowly, and to consume a bland diet. No formal or scheduled post-procedure C. difficile testing was scheduled. Repeat stool testing was done only for suggestive recurrent symptoms.8

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