1223. Intestinal Microbiota Transplantation (Fecal Transplantation) for Clostridium difficile Infection–A Single Center Experience
Session: Oral Abstract Session: Clinical Investigation and Experimental Medicine
Friday, October 19, 2012: 2:45 PM
Room: SDCC 23ABC
Background: Clostridium difficile infection (CDI) recurs in at least one third of patients and results in profound morbidity. Lack of response to conventional treatment with metronidazole and vancomycin results in readmissions, extends hospital stay and requires expensive supportive care and infection control measures. Complications include toxic megacolon leading to colectomy and/or death. Restoring normal fecal flora through IMT has been successful in curing CDI in stable patients with recurrent disease and in rare cases for severe/fulminant CDI.

Methods: Patients seen at Henry Ford Heath System (May 2010- December 2011) with moderate and recurrent CDI or severe/fulminant CDI not responding to conventional treatment were selected to receive IMT. Patients underwent IMT through naso-gastric route (NGT) or through a colonoscopy. Donors were screened for negative serology for HIV, Hepatitis A, B and C and syphilis. Donor stool was checked for negative Clostridium difficile DNA by PCR. Fresh donor stool specimen (approximately 30-50 gm) was homogenized with warm tap water and filtered through gauze. We instilled 120-180 ml of the filtered stool and a 20 ml of free water flush. In colonoscopy, 300-500 ml of filtered stool was used. Primary outcome was clinical improvement (resolution of diarrhea), while secondary outcome was recurrence within 100 days.

Results : Sixty-eight patients with moderate to severe CDI received IMT due to recurrent disease or as a last resort in lieu of colectomy. Median age was 66 years (range 16-93). Twenty-eight (41.17 %) had severe/fulminant CDI. Twelve (17.64 %) had IMT through colonoscopy and 6 (8.82 %) had it through NGT in the out patient setting. Fifty (73.52 %) had IMT in the in-patient setting; all via NGT. All patients (100%) tolerated the procedure well with no adverse events and recovered dramatically within a time frame of 1-4 days after receiving IMT. There was no recurrence of CDI documented in 100% of the patients in the following 100 days.

Conclusion : IMT is a simple procedure to prevent recurrence of CDI and is life-saving in severe/fulminant CDI. This procedure is safe and effective in inpatient and out patient settings. Further studies are warranted to consider IMT as a first line therapy in patients at high risk for recurrence.

Laila Shiekh Sroujieh, MD1, Mona Hassan, MD1, Hadeel Zainah, MD2, George Alangaden, MD3, Sravan Jeepalyam4, Miguel Emilio Morilla Holguin4, Laura Johnson, MD5, Marcus Zervos, MD5 and Mayur Ramesh, MD2, (1)Internal Medicine, Wayne State University, Henry Ford Health System, Detroit, MI, (2)Infectious Diseases, Wayne State University, Henry Ford Health System, Detroit, MI, (3)Infectious Disease, Wayne State Universoty, Henry Ford Health System, Detroit, MI, (4)Henry Ford Hospital, Detroit, MI, (5)Infectious Disease, Wayne State University, Henry Ford Health System, Detroit, MI

Disclosures:

L. Shiekh Sroujieh, None

M. Hassan, None

H. Zainah, None

G. Alangaden, None

S. Jeepalyam, None

M. E. Morilla Holguin, None

L. Johnson, None

M. Zervos, None

M. Ramesh, None

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