Date of Graduation

8-14-2010

Degree Type

Capstone Project

Degree Name

Master of Science in Physician Assistant Studies

First Advisor

Mary Von PA-C, MS, DFAAPA

Second Advisor

Annjanette Sommers MS, PAC

Third Advisor

Rob Rosenow PharmD, OD

Abstract

Background: Clostridium difficile infection (CDI) has emerged as a rapidly growing problem associated with the widespread use of broad-spectrum antibiotics. These antibiotics disrupt the natural bacterial flora in the colon and create an opportunity for C. difficile to invade and multiply. Current treatment with oral vancomycin and metronidazole is effective in many cases, however up to 35% of patients experience a relapse of CDI after completion of treatment, placing them at increased risk for recurrent C. difficile infections (RCDIs). Alternative therapies consist of probiotic and immunotherapy treatments, which are helpful in preventing CDI, but not at stopping the infection once it exists. Surgery is also an option, however it has many serious implications. Recently, fecal bacteriotherapy, or stool transplantation, has been successful at eradicating RCDI. Fecal bacteriotherapy uses the complete normal human flora as a therapeutic probiotic mixture of living organisms, transporting the healthy flora from a donor to a recipient with RCDI. The therapeutic use of fecal bacteriotherapy in the treatment of RCDI is reviewed here.

Methods: A systematic review was conducted using Medline, EBSCOhost and Web of Science, utilizing the keywords Clostridium difficile, bacteriotherapy and pseudomembranous colitis. Relevant articles were found and cross-referenced; references were reviewed for additional pertinent materials. At the time of this review, there are no RCTs published, therefore this review focuses on case series and case reports.

Results: Four case reports and case studies were reviewed and include a total of 26 patients. Each patient had at least two recurrences of CDI prior to receiving fecal bacteriotherapy treatment. Eighteen patients received treatment through the upper GI tract via nasogastric tube, while eight patients received therapy through the lower GI tract via colonoscope or fecal enema. Most patients were treated in the outpatient setting. Treatment response was similar in all methodologies, with patients reporting a decrease in diarrhea almost immediately. All patients, except one, remained free from any CDI recurrence through the follow-up period of 90 days to five years.

Conclusion: RCDI is an increasing problem in our medical community. Very difficult to treat, it takes a heavy toll on both patients and providers. Other treatment options, such as probiotics and immunotherapy, have had minimal successes. Fecal bacteriotherapy is a safe, rapid and highly effective option for the treatment of RCDI. Despite inadequacies in the current published literature, the studies appraised in this review support the therapeutic benefits of fecal bacteriotherapy for the treatment or RCDI and suggest potential for this inexpensive and minimally-risky treatment modality to undergo further investigations for clinical use.

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