Document Detail


Duodenal infusion of donor feces for recurrent Clostridium difficile.
MedLine Citation:
PMID:  23323867     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.).
Authors:
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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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2013-01-16
Journal Detail:
Title:  The New England journal of medicine     Volume:  368     ISSN:  1533-4406     ISO Abbreviation:  N. Engl. J. Med.     Publication Date:  2013 Jan 
Date Detail:
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    
Other Details:
Languages:  eng     Pagination:  407-15     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Administration, Oral
Aged
Anti-Bacterial Agents / therapeutic use*
Clostridium difficile*
Combined Modality Therapy
Diarrhea / drug therapy,  microbiology,  therapy*
Duodenum
Feces / microbiology*
Female
Humans
Intubation, Gastrointestinal
Male
Metagenome
Middle Aged
Recurrence
Therapeutic Irrigation
Vancomycin / therapeutic use*
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents; 6Q205EH1VU/Vancomycin
Comments/Corrections
Comment In:
Gastroenterology. 2013 Nov;145(5):1153   [PMID:  24055639 ]
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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