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

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.