Faecal microbiota transplantation plus selected use of vancomycin for severe‐complicated Clostridium difficile infection: description of a protocol with high success rate
Open accessAbstract
BACKGROUND: Severe and severe/complicated Clostridium difficile infection (CDI) can result in ICU admission, sepsis, toxic megacolon and death. In this setting, colectomy is the standard of care but it is associated with a 50% mortality. AIM: To evaluate safety and efficacy of a sequential faecal microbiota transplantation (FMT) and antibiotic protocol in severe and severe/complicated CDI patients who are at high risk for colectomy. METHODS: All patients with severe and severe/complicated CDI refractory to oral vancomycin ± rectal vancomycin and intravenous metronidazole therapy were offered FMT. Treatment consisted of sequential FMTs via colonoscopy with the need for repeat FMT and continued vancomycin guided by clinical response and pseudomembranes at colonoscopy. RESULTS: A total of 29 patients underwent FMT between July 2013 and August 2014. The overall treatment response of endoscopic sequential FMT was 93% (27/29), with 100% (10/10) for severe CDI and 89% (17/19) for severe/complicated CDI. A single FMT was performed in 62%, two FMTs were performed in 31% and three FMTs in 7% of patients. The use of non-CDI antibiotics predicted repeat FMT (odds ratio = 17.5). The 30-day all-cause mortality after FMT was 7%, and the cumulative 3-month survival was 76%. Of the two patients who died within 30 days, one underwent colectomy and succumbed to sepsis; the other died from septic shock related to CDI. CONCLUSION: The success of a treatment protocol for severe and severe/complicated involving faecal microbiota transplantation and continued vancomycin in selected patients was high, and it warrants further evaluation.
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Repeating FMT after a failure is a well-established way to increase overall efficacy rates in patients with CDI.
“Repeating FMT after a failure is a well-established way to increase overall efficacy rates in patients with CDI.”
From Key determinants of success in fecal microbiota transplantation: From microbiome to clinic (2023) · cites this paper as [103]
Sequential FMT plus vancomycin was a successful strategy in patients with severe CDI.
“This observation was replicated by Fischer and colleagues, who found that sequential FMT plus vancomycin was a successful strategy in patients with severe CDI.”
From Key determinants of success in fecal microbiota transplantation: From microbiome to clinic (2023) · cites this paper as [103]
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- Authors
- Fischer, M., Sipe, B. W., Rogers, N. A., Cook, G. K., Robb, B. W., Vuppalanchi, R., & Rex, D. K.
- Affiliations
- Indiana University Indianapolis (US)
- Community Hospital Anderson IN USA
- Corresponding author
- Fischer, M.
- Venue
- Alimentary Pharmacology & Therapeutics
- Publisher
- Wiley
- Published
- 2015-06-19
- Volume
- 42
- Issue
- 4
- Pages
- 470-476
- ISSN
- 0269-2813 (ISSN-L)
- 1365-2036
- OpenAlex
- W1916150944
- Cited by
- 168
- References
- 17
- Citations by year
- 2026: 4 · 2025: 10 · 2024: 10 · 2023: 4 · 2022: 13 · 2021: 15 · 2020: 20 · 2019: 26 · 2018: 23 · 2017: 22 · 2016: 18 · 2015: 3
- FWCI
- 17.09
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Alimentary Pharmacology & Therapeutics (publishedVersion)
- PubMed (publishedVersion)
- IUScholarWorks (Indiana University) (submittedVersion)
- Author eBooks
- Topics
- Health Sciences › Medicine › Infectious Diseases › Clostridium difficile and Clostridium perfringens research
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Clinical Biochemistry › Bacterial Identification and Susceptibility Testing
- Keywords
- Clostridium difficile infection, fecal microbiota transplantation, vancomycin, colectomy avoidance, antibiotic therapy, treatment efficacy, mortality, sepsis, toxic megacolon
- MeSH terms
- Fecal Microbiota Transplantation, Adult, Aged, Aged, 80 and over, Anti-Bacterial Agents, Clostridium Infections, Colectomy, Colonoscopy, Female, Humans, Male, Metronidazole, Middle Aged, Retrospective Studies, Shock, Septic, Vancomycin, Clostridioides difficile, Sepsis
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