According to the U.S. Center for Disease Control and Prevention, Clostridium difficile was responsible for 453 000 infections and approximately 29 000 deaths in the United States in 2011 alone. Newer, more virulent, antibiotic-resistant strains of C. difficile are increasing rates of relapse making the disease is more difficult to control than ever before. Efficacy of fecal microbiota transplant (FMT) for recurrent, refractory C. difficile infection (CDI) has been proven in case studies and reports, but the first RCTs using this treatment option have been published and will be analyzed in this systematic review.
An exhaustive medical literature search was conducted using MEDLINE-Ovid, CINAHL, and Web of Science using the following keywords and searches: 1) fecal microbiota transplant and clostridium difficile and 2) clostridium difficile and feces and donor. The National Institute of Health clinical trials database was searched using the terms “fecal microbiota transplant,” “clostridium difficile and feces,” and “donor feces” for completed and published RCTs. Relevant articles for inclusion were assessed for quality using GRADE.
The search resulted in a total of 54 studies of which only two studies met inclusion criteria. The results from both the van Nood et al study and the Youngster et al study demonstrate the positive outcomes of treating recurrent, refractory CDI with fecal microbiota transplant (FMT). The van Nood et al study showed an overall cure in 15 of 16 patients (94%) with donor feces infusion compared to cure in 4 of 13 patients (31%) treated with vancomycin alone. According to the Youngster et al study, nasogastric tube (NGT) proves to be the safer, patient-preferred route of FMT administration and is comparably effective when compared to colonoscopy.
Based on the study results, FMT should be considered by clinicians as a safe and effective treatment option for certain patients with recurrent, refractory CDI. It also appears viable to spare patients risks of colonoscopy by administering the donor feces by upper GI route using NGT.
Fecal Microbiota Transplant (FMT), donor feces transplant, Clostridium difficile, C. diff, infection, diarrhea, humans, vancomycin, antibiotics, colonoscopy, NGT
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