NEW YORK (Reuters Health) Apr 10 - Instillation of donor fecal material in the colon of patients with refractory Clostridium difficile infection leads to rapid resolution of the condition in more than 90% of cases, investigators reported late last month. "Evidence continues to mount showing that FMT (fecal microbiota transplant) is a safe and effective treatment modality that enables rapid and sustained cure for patients who have experienced two or more prior episodes" of C. difficile infection, said Dr. Lawrence J. Brandt, at Montefiore Medical Center, Bronx, New York and colleagues in a March 29 online paper in the American Journal of Gastroenterology.
Antibiotic exposure can alter the balance of commensal colonic bacteria, which may predispose to infection with C. difficile, they note. "Re-establishment of the wide diversity of intestinal flora via the infusion of donor feces into the colon is the proposed mechanism by which FMT corrects this imbalance and enables normal bowel function," they explain.
This strategy has been tested in several previous studies (e.g., see Reuters Health report of January 26, 2012).
For the current study, the team looked at long-term outcomes in 77 patients who were contacted a mean of 17 months after being treated with colonoscopic FMT for recurrent C. difficile infection at five disparate centers in the US.
Average symptom duration before the procedure was 11 months, and the patients had received an average of five unsuccessful courses of conventional treatments. Within an average of five days after FMT, diarrhea resolved in 82% of patients and improved in 17%, according to the report.
Among the seven patients who did not respond, six were subsequently treated successfully with vancomycin and/or repeat FMT, the authors note.
Eight patients had late recurrence (after at least 90 days), all during treatment with antibiotics for infections unrelated to C. difficile. There were no late recurrences in patients who did not require antibiotics during follow-up.
The authors acknowledge that transmission of pathogens is a concern with FMT, but note that "there have been no adverse effects or complications directly attributed to FMT to date."
Dr. Brandt and colleagues say controlled trials are needed to prove the effectiveness of the fecal transplant strategy. In the meantime, they conclude, "FMT is a rational, durable, safe, and acceptable treatment option for patients with recurrent C. difficile infection."
SOURCE: bit.ly/HyyhOZ
Am J Gastroenterol 2012.