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Infusion of donor feces effectively treated C. difficile infection

Patients with recurrent Clostridium difficile infection experienced better outcomes when treated with an infusion of donor feces in addition to antibiotics in a recent study.

Researchers randomized adult patients with recurrent C. difficile infection to receive either 500 mg vancomycin orally four times daily for 14 days (n=13), the same vancomycin regimen in addition to bowel lavage (n=13), or 500 mg vancomycin orally four times a day for 4 days, then bowel lavage and infusion of donor feces via nasoduodenal tube (n=16). Efficacies in the relapse-free resolution of C. difficile-associated diarrhea after 10 weeks were evaluated.

Thirteen patients who received infusion (81%) experienced resolution after one procedure. Two of the remaining three participants experienced resolution after a second procedure for a cure rate of 94%.

Frequency of relapse in the noninfusion groups resulted in early study termination after interim analysis. Participants who received vancomycin alone experienced relapse-free resolution in 31% of cases, while resolution occurred in 23% of vancomycin and lavage patients (P<.001 for all comparisons with infusion). Investigators calculated cure rate ratios of infusion to vancomycin alone of 3.05 (99.9% CI, 1.08-290.05) and to vancomycin with lavage of 4.05 (99.9% CI, 1.21-290.12).

Infusion participants reported abdominal cramping (31% of cases) and minor diarrhea (94% of cases) on procedure day, but no other significant differences related to adverse events were observed between groups. After infusion, all nine recipients with data on fecal microbiota indicated bacterial diversity similar to healthy donors, with declines in Proteobacteria species and increases to clostridium clusters IV and XIVa and Bacteroidetes species bacteria (P<.05 for all differences). Eight patients maintained fecal bacterial diversity during follow-up.

“In this small, open-label, randomized controlled trial, we found that the infusion of donor feces is a potential therapeutic strategy against recurrent C. difficile infection,” the researchers concluded. “The infusion of donor feces, as compared with vancomycin therapy, resulted in better treatment outcomes. In particular, patients with multiple relapses of C. difficile infection benefited from this unconventional approach.”

Disclosure: See the study for a full list of relevant disclosures.