|Duodenal infusion of donor feces for recurrent Clostridium difficile.|
|PMID: 23323867 Owner: NLM Status: MEDLINE|
|BACKGROUND: Recurrent Clostridium difficile infection is difficult to treat, and failure rates for antibiotic therapy are high. We studied the effect of duodenal infusion of donor feces in patients with recurrent C. difficile infection.
METHODS: We randomly assigned patients to receive one of three therapies: an initial vancomycin regimen (500 mg orally four times per day for 4 days), followed by bowel lavage and subsequent infusion of a solution of donor feces through a nasoduodenal tube; a standard vancomycin regimen (500 mg orally four times per day for 14 days); or a standard vancomycin regimen with bowel lavage. The primary end point was the resolution of diarrhea associated with C. difficile infection without relapse after 10 weeks.
RESULTS: The study was stopped after an interim analysis. Of 16 patients in the infusion group, 13 (81%) had resolution of C. difficile-associated diarrhea after the first infusion. The 3 remaining patients received a second infusion with feces from a different donor, with resolution in 2 patients. Resolution of C. difficile infection occurred in 4 of 13 patients (31%) receiving vancomycin alone and in 3 of 13 patients (23%) receiving vancomycin with bowel lavage (P<0.001 for both comparisons with the infusion group). No significant differences in adverse events among the three study groups were observed except for mild diarrhea and abdominal cramping in the infusion group on the infusion day. After donor-feces infusion, patients showed increased fecal bacterial diversity, similar to that in healthy donors, with an increase in Bacteroidetes species and clostridium clusters IV and XIVa and a decrease in Proteobacteria species.
CONCLUSIONS: The infusion of donor feces was significantly more effective for the treatment of recurrent C. difficile infection than the use of vancomycin. (Funded by the Netherlands Organization for Health Research and Development and the Netherlands Organization for Scientific Research; Netherlands Trial Register number, NTR1177.).
|Els van Nood; Anne Vrieze; Max Nieuwdorp; Susana Fuentes; Erwin G Zoetendal; Willem M de Vos; Caroline E Visser; Ed J Kuijper; Joep F W M Bartelsman; Jan G P Tijssen; Peter Speelman; Marcel G W Dijkgraaf; Josbert J Keller|
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|Type: Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't Date: 2013-01-16|
|Title: The New England journal of medicine Volume: 368 ISSN: 1533-4406 ISO Abbreviation: N. Engl. J. Med. Publication Date: 2013 Jan|
|Created Date: 2013-01-31 Completed Date: 2013-02-07 Revised Date: 2014-02-06|
Medline Journal Info:
|Nlm Unique ID: 0255562 Medline TA: N Engl J Med Country: United States|
|Languages: eng Pagination: 407-15 Citation Subset: AIM; IM|
|APA/MLA Format Download EndNote Download BibTex|
Anti-Bacterial Agents / therapeutic use*
Combined Modality Therapy
Diarrhea / drug therapy, microbiology, therapy*
Feces / microbiology*
Vancomycin / therapeutic use*
|0/Anti-Bacterial Agents; 6Q205EH1VU/Vancomycin|
Gastroenterology. 2013 Nov;145(5):1153
Gastroenterology. 2013 Nov;145(5):1151-3 [PMID: 24055638 ]
N Engl J Med. 2013 May 30;368(22):2145 [PMID: 23718168 ]
N Engl J Med. 2013 May 30;368(22):2144 [PMID: 23718172 ]
N Engl J Med. 2013 May 30;368(22):2144 [PMID: 23718171 ]
N Engl J Med. 2013 May 30;368(22):2143-4 [PMID: 23718170 ]
Rev Clin Esp. 2013 May;213(4):213 [PMID: 23814791 ]
Evid Based Med. 2013 Dec;18(6):220-1 [PMID: 23616152 ]
N Engl J Med. 2013 May 30;368(22):2143 [PMID: 23718169 ]
N Engl J Med. 2013 Jan 31;368(5):474-5 [PMID: 23323865 ]
Dtsch Med Wochenschr. 2013 Mar;138(12):566 [PMID: 23483414 ]
Nat Rev Gastroenterol Hepatol. 2013 Mar;10(3):129 [PMID: 23358398 ]
Z Gastroenterol. 2013 Dec;51(12):1441-3 [PMID: 24338758 ]
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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