Fecal Microbiota Transplantation for Refractory and Recurrent Clostridium difficile Infection: A Case Series of Nine Patients

Byoung Wook Bang; Jin-Seok Park; Hyung Kil Kim; Yong Woon Shin; Kye Sook Kwon; Hea Yoon Kwon; Ji Hyeon Baek; Jin-Soo Lee

doi:10.4166/kjg.2017.69.4.226

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Bang, Park, Kim, Shin, Kwon, Kwon, Baek, and Lee: Fecal Microbiota Transplantation for Refractory and Recurrent Clostridium difficile Infection: A Case Series of Nine Patients

Original Article

Korean J Gastroenterol 2017;69(4):226-231.

Published online: 4 October 2017

DOI: https://doi.org/10.4166/kjg.2017.69.4.226

Fecal Microbiota Transplantation for Refractory and Recurrent Clostridium difficile Infection: A Case Series of Nine Patients

Byoung Wook Bang, Jin-Seok Park, Hyung Kil Kim, Yong Woon Shin, Kye Sook Kwon, Hea Yoon Kwon¹, Ji Hyeon Baek¹, Jin-Soo Lee¹

Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea

¹Divisions of Gastroenterology and Infectious Diseases, Inha University School of Medicine, Incheon, Korea

Correspondence to: Yong Woon Shin, Division of Gastroenterology, Department of Internal Medicine, Inha University Hospital, 27 Inhang-ro, Jung-gu, Incheon 22332, Korea. Tel: +82-32-890-2548, Fax: +82-32-890-2549, E-mail: ywshin@inha.ac.kr

Received 5 December 2016 Revised 15 January 2017 Accepted 15 January 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims

Fecal microbiota transplantation (FMT) is a highly effective therapy for refractory and recurrent Clostridium difficile infection (CDI). Despite its excellent efficacy and recent widespread use, FMT has not been widely used in South Korea thus far. We describe our experience with FMT to treat refractory/recurrent CDI.

Methods

We conducted a chart review of patients who underwent FMT for refractory/recurrent CDI at Inha University Hospital, between March 2014 and June 2016. The demographic information, treatment data, and adverse events were reviewed. FMT was administered via colonoscopy and/or duodenoscopy. All stool donors were rigorously screened to prevent infectious disease transmission.

Results

FMT was performed in nine patients with refractory/recurrent CDI. All patients were dramatically cured. Bowel movement was normalized within one week after FMT. There were no procedure-related adverse events, except aspiration pneumonia in one patient. During the follow-up period (mean 11.4 months), recurrence of CDI was observed in one patient at one month after FMT due to antibiotics.

Conclusions

FMT is a safe, well-tolerated and highly effective treatment for refractory/recurrent CDI. Although there are many barriers to using FMT, we expect that FMT will be widely used to treat refractory/recurrent CDI in South Korea.

Keywords: Fecal microbiota transplantation, Clostridium difficile, Colonoscopy, Gastrointestinal microbiome

References

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Fig. 1.

Bowel movement change of before and after fecal microbiota transplantation (FMT). The mean bowel movement was 5.5±3.1 stools per day, one day prior to FMT. The mean bowel movements decreased 1.4±1.1 stools per day, at four days after FMT, and normalized within one week.

Fig. 2.

Colonoscopic findings of pseudomembranous colitis. Colonoscopic finding at the time of diagnosis of pseudomembranous colitis (A), after metronidazole for 14 days (B), after vancomycin for 10 days (C), during fecal microbiota transplantation (FMT) (D) and one month after FMT (E).

Table 1.

Demographics of the Patients

No	Sex	Age	Underlying illness	No. of CDI episode	Disease severity	Index infection	Symptom duration (day)	PMC	Antibiotic therapy before FMT (day) ^a
1	F	66	Brain tumor, CVA	1	Severe	UTI	20	No	MTZ (7)
									VNC (8)
2	F	70	s/p Rectal Ca	3	Severe	Acute colitis	100	Yes	MTZ (10)
									VNC (28)
3	M	91	CVA, bed ridden	1	Complicated	UTI	60	No	MTZ (10)
									VNC (55)
4	F	94	CVA, bed ridden	2	Moderate	Pneumonia	120	No	MTZ (35)
									VNC (50)
5	M	82	Back pain, bed ridden	1	Severe	Pneumonia	20	Yes	MTZ (8)
									VNC (5)
6	M	56	CVA, bed ridden	1	Severe	Pneumonia	14	Yes	MTZ (9)
									VNC (8)
7	M	57	None	3	Severe	Diverticulitis	60	Yes	MTZ (14)
									VNC (10)
8	F	55	Brain tumor complicated UTI	3	Severe	Recurrent UTI	20	Yes	MTZ (0)
									VNC (15)
9	M	82	Dementia, bed ridden	1	Severe	Unknown	30	Yes	MTZ (7)
									VNC (7)

F, female; M, male; CVA, cerebrovascular accident; UTI, urinary tract infection; PMC, pseudomembranous colitis; FMT, fecal microbiota transplantation; MTZ, metronidazole; VNC, vancomycin.

^a Duration of antibiotics use before fecal microbiota transplantation.

Disease severity followed the criteria of Leffler and Lamont.²²

Table 2.

Technical Methods and Clinical Outcomes of FMT

No	No. of FMT	Route of FMT	Donor relationship	Stool weight (g)	Infusion volume (mL)	Adverse effects	Recurrence	Follow-up duration (month)
1	1	Lower	Daughter	50	500	None	None	12
2	1	Lower	Daughter	70	500	None	None	27
3	1	Upper	Son	50	350	Aspiration pneumonia	None	17
4	1	Lower	Daughter	50	500	None	None	13
5	1	Lower	Unrelated	50	500	None	None	17
6	1	Lower	Unrelated	80	700	None	Yes	9
7	1	Lower	Wife	50	550	None	None	4
8	1	Both	Daughter	25	500	None	None	2
9	1	Lower	Unrelated	70	700	None	None	2

FMT, fecal microbiota transplantation.

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