259335 Stool Transplantation for Recurrent Clostridium difficile Infection: Report on a Large Case Series

Monday, October 29, 2012 : 10:35 AM - 10:50 AM

Timothy Rubin, MD , Digestive Health Center, Essentia Health Duluth Clinic, Duluth, MN
Charles E. Gessert, MD, MPH , Division of Research, Essentia Institute of Rural Health, Duluth, MN
Johannes Aas, MD , Digestive Health Center, Essentia Health Duluth Clinic, Duluth, MN
Johan Bakken, MD, PhD , St. Luke's Infectious Disease Associates, St. Luke's Hospital, Duluth, MN
Background The principal problem encountered in the treatment of C. difficile infection is recurrence. Once a patient has had a single recurrence, the risk of subsequent recurrences is significantly higher. Further treatment with additional courses of antibiotics is associated with diminishing rates of cure.

Methods In the 1990s, one of the investigators (JA) developed a stool transplantation protocol, with screening of donors and suspension and filtering of stool prior to administration via NG tube. In 2011, patient records from 2002-2010 were reviewed to identify stool transplantations provided for patients with laboratory-confirmed C. difficile infection and 2 or more recurrences following adequate treatment with antibiotics. Records for 89 transplantations were reviewed.

Results After exclusions (principally due to incomplete data) 78 stool transplantations were included in the analysis. Overall, 60 of these transplantations (76.9%) resulted in clinical resolution of the recurrent C. difficile infection. These cases included 3 patients who had positive tests for C. difficile after resolution of symptoms and were presumed to be chronic C. difficile carriers, and 2 patients without follow up laboratory results. Of the 18 transplantations that resulted in clinical relapses, 9 patients responded to subsequent courses of vancomycin with clinical resolution of C. difficile infection.

Conclusions The use of stool from a healthy donor to reestablish gastrointestinal flora that inhibits the growth of C. difficile has several important advantages over all of the regimens currently in use: lower cost and less use of the antibiotics that are part of the original etiology of the condition.

Learning Areas:
Clinical medicine applied in public health
Protection of the public in relation to communicable diseases including prevention or control

Learning Objectives:
1. Describe the relationship between Clostridium difficile infection and normal stool flora. 2. Describe the steps used in stool transplantation to restore normal stool flora.

Keywords: Infectious Diseases, Alternative Medicine/Therapies

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have worked on every stage of this research, from design through data collection and analysis.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.