Fecal Microbiota Transplant for Recurrent Clostridium difficile Infection: Mayo Clinic in Arizona Experience

• Published in: Mayo Clinic proceedings Vol. 88; no. 8; pp. 799 - 805
• Main Authors: Patel, Neal C., MD, Griesbach, Cheryl L., RN, DiBaise, John K., MD, Orenstein, Robert, DO
• Format: Journal Article
• Language: English
• Published: England Elsevier Inc 01-08-2013; Elsevier, Inc; Elsevier Limited
• Subjects: Abdominal Pain - physiopathology; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents - therapeutic use; Care and treatment; Clostridium difficile - pathogenicity; Clostridium infections; Colonoscopy - methods; Diarrhea - physiopathology; Drug Resistance, Multiple, Bacterial; Enterocolitis, Pseudomembranous - microbiology; Enterocolitis, Pseudomembranous - physiopathology; Enterocolitis, Pseudomembranous - therapy; Feces - microbiology; Female; Humans; Internal Medicine; Intestines - microbiology; Male; Methods; Microbiota; Microbiota (Symbiotic organisms); Middle Aged; Patient outcomes; Recurrence; Retrospective Studies; Safety and security measures; Transplantation - methods; Treatment Outcome; Arizona; NAP1; CDI; fecal microbiota transplant; FMT; PCR ribotype 027/North American pulsed-field type 1; Clostridium difficile infection
• ISSN: 0025-6196; 1942-5546
• DOI: 10.1016/j.mayocp.2013.04.022

Abstract Objective To report the initial experience of treating recurrent Clostridium difficile infection (CDI) with fecal microbiota transplant (FMT) at Mayo Clinic in Arizona. Patients and Methods The study retrospectively reviewed FMTs performed at Mayo Clinic in Arizona between January 1, 2011, and January 31, 2013. All the recipients had multiple recurrent CDIs unresponsive to traditional antibiotic drug therapy. A standardized protocol was developed to identify patients, screen donors, perform FMT, and determine outcomes via telephone surveys. Results Thirty-one patients (mean ± SD age, 61.26±19.34 years) underwent FMT. Median time from index infection to FMT was 340 days. Ninety-seven percent (29 of 30) of patients reported substantial improvement or resolution of diarrhea (median time to improvement, 3 days), 74% (17 of 23) reported improvement or resolution of abdominal pain (median time to improvement, 3 days), and 55% (16 of 29) had improvement or resolution of fatigue (median time to improvement, 6 days). Three patients underwent repeated FMT owing to persistent symptoms; 2 reported improvement in diarrhea with the second therapy. No serious adverse events directly related to FMT were reported. Conclusion A standardized regimen of FMT for recurrent CDI is safe, is highly effective, and can be provided using a relatively simple protocol.