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DOI: 10.1055/s-0040-1701233
Fecal Microbiota Transplantation: Redefining Surgical Management of Refractory Clostridium difficile Infection
Publication History
Publication Date:
25 February 2020 (online)
Abstract
Fecal microbiota transplantation (FMT) is the process of transplanting stool from a healthy donor into the gut of a diseased individual for therapeutic purposes. It has a clearly defined role in the treatment of recurrent Clostridium difficile (reclassified as “Clostridioides difficile”) infection (CDI), with cure rates over 90% and decreased rates of subsequent recurrence compared with anti-CDI antibiotics. There is emerging evidence that FMT is also effective in the treatment of severe and fulminant CDI, with associated decreases in mortality and colectomy rates compared with standard antibiotic therapy. FMT shows promise as salvage therapy for critically-ill CDI patients refractory to maximum medical therapy and not deemed to be surgical candidates. FMT should be considered early in the course of severe CDI and should be delivered immediately in patients with signs of refractory CDI. Expansion of FMT's use along the spectrum of CDI severity has potential to decrease associated rates of mortality and colectomy.
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References
- 1 Zhang F, Luo W, Shi Y, Fan Z, Ji G. Should we standardize the 1,700-year-old fecal microbiota transplantation?. Am J Gastroenterol 2012; 107 (11) 1755 , author reply 1755–1756
- 2 Lawson PA, Citron DM, Tyrrell KL, Finegold SM. Reclassification of Clostridium difficile as Clostridioides difficile (Hall and O'Toole 1935) Prévot 1938. Anaerobe 2016; 40: 95-99
- 3 Khoruts A, Sadowsky MJ. Understanding the mechanisms of faecal microbiota transplantation. Nat Rev Gastroenterol Hepatol 2016; 13 (09) 508-516
- 4 McFarland LV, Surawicz CM, Greenberg RN. , et al. A randomized placebo-controlled trial of Saccharomyces boulardii in combination with standard antibiotics for Clostridium difficile disease. JAMA 1994; 271 (24) 1913-1918
- 5 Chang JY, Antonopoulos DA, Kalra A. , et al. Decreased diversity of the fecal Microbiome in recurrent Clostridium difficile-associated diarrhea. J Infect Dis 2008; 197 (03) 435-438
- 6 Wilson KH, Perini F. Role of competition for nutrients in suppression of Clostridium difficile by the colonic microflora. Infect Immun 1988; 56 (10) 2610-2614
- 7 Le Lay C, Dridi L, Bergeron MG, Ouellette M, Fliss IL. Nisin is an effective inhibitor of Clostridium difficile vegetative cells and spore germination. J Med Microbiol 2016; 65 (02) 169-175
- 8 Rea MC, Sit CS, Clayton E. , et al. Thuricin CD, a posttranslationally modified bacteriocin with a narrow spectrum of activity against Clostridium difficile . Proc Natl Acad Sci U S A 2010; 107 (20) 9352-9357
- 9 Weingarden AR, Dosa PI, DeWinter E. , et al. Changes in colonic bile acid composition following fecal microbiota transplantation are sufficient to control Clostridium difficile germination and growth. PLoS One 2016; 11 (01) e0147210
- 10 Belkaid Y, Hand TW. Role of the microbiota in immunity and inflammation. Cell 2014; 157 (01) 121-141
- 11 Surawicz CM, Brandt LJ, Binion DG. , et al. Guidelines for diagnosis, treatment, and prevention of Clostridium difficile infections. Am J Gastroenterol 2013; 108 (04) 478-498 , quiz 499
- 12 McDonald LC, Gerding DN, Johnson S. , et al. Clinical Practice Guidelines for Clostridium difficile infection in adults and children: 2017 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin Infect Dis 2018; 66 (07) 987-994
- 13 Kassam Z, Lee CH, Yuan Y, Hunt RH. Fecal microbiota transplantation for Clostridium difficile infection: systematic review and meta-analysis. Am J Gastroenterol 2013; 108 (04) 500-508
- 14 Gough E, Shaikh H, Manges AR. Systematic review of intestinal microbiota transplantation (fecal bacteriotherapy) for recurrent Clostridium difficile infection. Clin Infect Dis 2011; 53 (10) 994-1002
- 15 Cammarota G, Masucci L, Ianiro G. , et al. Randomised clinical trial: faecal microbiota transplantation by colonoscopy vs. vancomycin for the treatment of recurrent Clostridium difficile infection. Aliment Pharmacol Ther 2015; 41 (09) 835-843
- 16 Johnson S. Recurrent Clostridium difficile infection: a review of risk factors, treatments, and outcomes. J Infect 2009; 58 (06) 403-410
- 17 Cornely OA, Crook DW, Esposito R. , et al; OPT-80-004 Clinical Study Group. Fidaxomicin versus vancomycin for infection with Clostridium difficile in Europe, Canada, and the USA: a double-blind, non-inferiority, randomised controlled trial. Lancet Infect Dis 2012; 12 (04) 281-289
- 18 Cammarota G, Ianiro G, Tilg H. , et al; European FMT Working Group. European consensus conference on faecal microbiota transplantation in clinical practice. Gut 2017; 66 (04) 569-580
- 19 Lee CH, Steiner T, Petrof EO. , et al. Frozen vs fresh fecal microbiota transplantation and clinical resolution of diarrhea in patients with recurrent Clostridium difficile infection: a randomized clinical trial. JAMA 2016; 315 (02) 142-149
- 20 Jiang ZD, Ajami NJ, Petrosino JF. , et al. Randomised clinical trial: faecal microbiota transplantation for recurrent Clostridum difficile infection - fresh, or frozen, or lyophilised microbiota from a small pool of healthy donors delivered by colonoscopy. Aliment Pharmacol Ther 2017; 45 (07) 899-908
- 21 Staley C, Hamilton MJ, Vaughn BP. , et al. Successful resolution of recurrent Clostridium difficile infection using freeze-dried, encapsulated fecal microbiota; pragmatic cohort study. Am J Gastroenterol 2017; 112 (06) 940-947
- 22 Panchal P, Elliott RJ, Budree S. , et al. 1010 - scaling access to fecal microbiota transplantation for recurrent Clostridium difficle infection in the United States: a geospatial time-series analysis from 2013 to 2017. Gastroenterology 2018; 154 (06) (Suppl. 01) S-190-S-191
- 23 Furuya-Kanamori L, Doi SAR, Paterson DL. , et al. Upper versus lower gastrointestinal delivery for transplantation of fecal microbiota in recurrent or refractory Clostridium difficile infection: a collaborative analysis of individual patient data from 14 studies. J Clin Gastroenterol 2017; 51 (02) 145-150
- 24 Bhangu A, Nepogodiev D, Gupta A, Torrance A, Singh P. ; West Midlands Research Collaborative. Systematic review and meta-analysis of outcomes following emergency surgery for Clostridium difficile colitis. Br J Surg 2012; 99 (11) 1501-1513
- 25 Steele SR, McCormick J, Melton GB. , et al. Practice parameters for the management of Clostridium difficile infection. Dis Colon Rectum 2015; 58 (01) 10-24
- 26 Kulaylat AS, Kassam Z, Hollenbeak CS, Stewart Sr DB. A surgical Clostridium-associated risk of death score predicts mortality after colectomy for Clostridium difficile . Dis Colon Rectum 2017; 60 (12) 1285-1290
- 27 Hensgens MP, Dekkers OM, Goorhuis A, LeCessie S, Kuijper EJ. Predicting a complicated course of Clostridium difficile infection at the bedside. Clin Microbiol Infect 2014; 20 (05) O301-O308
- 28 Na X, Martin AJ, Sethi S. , et al. A multi-center prospective derivation and validation of a clinical prediction tool for severe Clostridium difficile infection. PLoS One 2015; 10 (04) e0123405
- 29 van der Wilden GM, Chang Y, Cropano C. , et al. Fulminant Clostridium difficile colitis: prospective development of a risk scoring system. J Trauma Acute Care Surg 2014; 76 (02) 424-430
- 30 Beauregard-Paultre C, Chakra CNA, McGeer A. , et al. External validation of clinical scores to predict complications of Clostridium difficile infection. Open Forum Infect Dis 2017; 4: S402-S402
- 31 Neal MD, Alverdy JC, Hall DE, Simmons RL, Zuckerbraun BS. Diverting loop ileostomy and colonic lavage: an alternative to total abdominal colectomy for the treatment of severe, complicated Clostridium difficile associated disease. Ann Surg 2011; 254 (03) 423-427 , discussion 427–429
- 32 Fashandi AZ, Martin AN, Wang PT. , et al. An institutional comparison of total abdominal colectomy and diverting loop ileostomy and colonic lavage in the treatment of severe, complicated Clostridium difficile infections. Am J Surg 2017; 213 (03) 507-511
- 33 Cheng YW, Fischer M. the present status of fecal microbiota transplantation and its value in the elderly. Curr Treat Options Gastroenterol 2017; 15 (03) 349-362
- 34 Zainah H, Hassan M, Shiekh-Sroujieh L, Hassan S, Alangaden G, Ramesh M. Intestinal microbiota transplantation, a simple and effective treatment for severe and refractory Clostridium difficile infection. Dig Dis Sci 2015; 60 (01) 181-185
- 35 Agrawal M, Aroniadis OC, Brandt LJ. , et al. The long-term efficacy and safety of fecal microbiota transplant for recurrent, severe, and complicated Clostridium difficile infection in 146 elderly individuals. J Clin Gastroenterol 2016; 50 (05) 403-407
- 36 Weingarden AR, Hamilton MJ, Sadowsky MJ, Khoruts A. Resolution of severe Clostridium difficile infection following sequential fecal microbiota transplantation. J Clin Gastroenterol 2013; 47 (08) 735-737
- 37 Fischer M, Sipe BW, Rogers NA. , et al. Faecal microbiota transplantation plus selected use of vancomycin for severe-complicated Clostridium difficile infection: description of a protocol with high success rate. Aliment Pharmacol Ther 2015; 42 (04) 470-476
- 38 Fischer M, Sipe B, Cheng YW. , et al. Fecal microbiota transplant in severe and severe-complicated Clostridium difficile: a promising treatment approach. Gut Microbes 2017; 8 (03) 289-302
- 39 Ianiro G, Masucci L, Quaranta G. , et al. Randomised clinical trial: faecal microbiota transplantation by colonoscopy plus vancomycin for the treatment of severe refractory Clostridium difficile infection-single versus multiple infusions. Aliment Pharmacol Ther 2018; 48 (02) 152-159
- 40 Hocquart M, Lagier J-C, Cassir N. , et al. Early fecal microbiota transplantation improves survival in severe Clostridium difficile infections. Clin Infect Dis 2018; 66 (05) 645-650
- 41 Cammarota G, Ianiro G, Magalini S, Gasbarrini A, Gui D. Decrease in surgery for Clostridium difficile infection after starting a program to transplant fecal microbiota. Ann Intern Med 2015; 163 (06) 487-488
- 42 Cheng Y-W, Phelps E, Rogers N. , et al. Fecal Microbiota Transplant Decreases Mortality in Patients with Severe and Severe-Complicated Clostridium difficile Infection, Including Cases Not Eligible for Colectomy. World Congress of Gastroenterology at ACG; 2017 ; Orlando, FL. Clin Gastro Hepato 2020. Epub ahead of print
- 43 Seder CW, Villalba Jr MR, Robbins J. , et al. Early colectomy may be associated with improved survival in fulminant Clostridium difficile colitis: an 8-year experience. Am J Surg 2009; 197 (03) 302-307
- 44 Andremont A. Too early to recommend early fecal microbiota transplantation in patients with severe Clostridium difficile infection, or not too early?. Clin Infect Dis 2018; 66 (05) 651-652
- 45 Brandt LJ, Borody TJ, Campbell J. Endoscopic fecal microbiota transplantation: “first-line” treatment for severe Clostridium difficile infection?. J Clin Gastroenterol 2011; 45 (08) 655-657
- 46 Byar DP, Schoenfeld DA, Green SB. , et al. Design considerations for AIDS trials. N Engl J Med 1990; 323 (19) 1343-1348
- 47 Yazdanpanah Y, Horby P, van Griensven J. , et al. Drug assessment in the Ebola virus disease epidemic in west Africa. Lancet Infect Dis 2015; 15 (11) 1258-1258
- 48 Allegretti JR, Kassam Z, Osman M, Budree S, Fischer M, Kelly CR. The 5D framework: a clinical primer for fecal microbiota transplantation to treat Clostridium difficile infection. Gastrointest Endosc 2018; 87 (01) 18-29
- 49 Ananthakrishnan AN, McGinley EL, Saeian K, Binion DG. Temporal trends in disease outcomes related to Clostridium difficile infection in patients with inflammatory bowel disease. Inflamm Bowel Dis 2011; 17 (04) 976-983
- 50 Jen MH, Saxena S, Bottle A, Aylin P, Pollok RC. Increased health burden associated with Clostridium difficile diarrhoea in patients with inflammatory bowel disease. Aliment Pharmacol Ther 2011; 33 (12) 1322-1331
- 51 Ananthakrishnan AN, McGinley EL, Binion DG. Excess hospitalisation burden associated with Clostridium difficile in patients with inflammatory bowel disease. Gut 2008; 57 (02) 205-210
- 52 Fischer M, Kao D, Kelly C. , et al. Fecal microbiota transplantation is safe and efficacious for recurrent or refractory Clostridium difficile infection in patients with inflammatory bowel disease. Inflamm Bowel Dis 2016; 22 (10) 2402-2409
- 53 Khoruts A, Rank KM, Newman KM. , et al. Inflammatory bowel disease affects the outcome of fecal microbiota transplantation for recurrent Clostridium difficile infection. Clin Gastroenterol Hepatol 2016; 14 (10) 1433-1438
- 54 Qazi T, Amaratunga T, Barnes EL, Fischer M, Kassam Z, Allegretti JR. The risk of inflammatory bowel disease flares after fecal microbiota transplantation: systematic review and meta-analysis. Gut Microbes 2017; 8 (06) 574-588
- 55 Len O, Rodríguez-Pardo D, Gavaldà J. , et al; Spanish Research Network for the Study of Infection in Transplantation. Outcome of Clostridium difficile-associated disease in solid organ transplant recipients: a prospective and multicentre cohort study. Transpl Int 2012; 25 (12) 1275-1281
- 56 Gellad ZF, Alexander BD, Liu JK. , et al. Severity of Clostridium difficile-associated diarrhea in solid organ transplant patients. Transpl Infect Dis 2007; 9 (04) 276-280
- 57 Boutros M, Al-Shaibi M, Chan G. , et al. Clostridium difficile colitis: increasing incidence, risk factors, and outcomes in solid organ transplant recipients. Transplantation 2012; 93 (10) 1051-1057
- 58 Dubberke ER, Burdette SD. ; AST Infectious Diseases Community of Practice. Clostridium difficile infections in solid organ transplantation. Am J Transplant 2013; 13 (Suppl. 04) 42-49
- 59 Kelly CR, Ihunnah C, Fischer M. , et al. Fecal microbiota transplant for treatment of Clostridium difficile infection in immunocompromised patients. Am J Gastroenterol 2014; 109 (07) 1065-1071
- 60 Cheng Y-W, Phelps EL, Ganipini V. , et al. Tu1875 - fecal microbiota transplantation for the treatment of clostridium difficile infection is efficacious and safe in solid organ transplant recipients. Am J Transplantation. PMID 300085388