Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Feb 14;15(2):e34998.
doi: 10.7759/cureus.34998. eCollection 2023 Feb.

Fecal Microbiota Transplantation for Fulminant Clostridioides Difficile Infection: A Combined Medical and Surgical Case Series

Ellen J Spartz  1 , Mina Estafanos  2 , Reema Mallick  3 , Wolfganag Gaertner  2 , Victor Vakayil  2 , Cyrus Jahansouz  2 , Rishav Aggarwal  2 , Sayeed Ikramuddin  2 , Alexander Khoruts  4 , James V Harmon  2
Affiliations

Fecal Microbiota Transplantation for Fulminant Clostridioides Difficile Infection: A Combined Medical and Surgical Case Series

Ellen J Spartz et al. Cureus. .

Abstract

Urgent abdominal colectomy is indicated for patients with fulminant Clostridioides difficile infection (CDI) when other medical therapies fail, yet mortality remains high. Fecal microbiota transplant is a less invasive alternative approach for patients with fulminant CDI. We report the 30-day complications of patients with fulminant CDI who underwent either abdominal colectomy, fecal microbiota transplantation (FMT), or FMT followed by abdominal colectomy (FMT-CO). Methods: We performed a single-center, retrospective case review of combined medical and surgical patients with CDI at a large academic medical center between 2008 and 2016. Cohorts were identified as patients with fulminant CDI who underwent total abdominal colectomy alone (CO), FMT alone (FMT), or FMT-CO. We analyzed patient demographics, history, comorbidities, clinical and laboratory variables, CDI severity scores, and mortality outcomes at 30 days. Results: We identified 5,150 patients with CDI at our center during the review period; 16 patients met the criteria for fulminant CDI and were included in this study, with four patients in the CO cohort, eight patients in the FMT cohort, and four patients in the FMT-CO cohort. Demographics and CDI severity scores were similar for all three groups, although the selected comorbidity profiles differed significantly among the three cohorts. The 30-day mortality rates for patients in the CO, FMT, and FMT-CO groups were 25%, 12.5%, and 25%, respectively. Conclusions: FMT is an alternative or adjunctive therapy to colectomy for patients with fulminant CDI that is not associated with increased mortality. Implementation of FMT protocols in clinical practice would be dependent on the availability of qualified transplant material and successful early identification of patients likely to benefit from FMT.

Keywords: c-diff; c. diff colitis; fecal microbiota transplantation (fmt); fecal microbiota transplantation in clostridium difficile infection; fulminant c. difficile infection; total colectomy.

PubMed Disclaimer

Conflict of interest statement

The authors have declared financial relationships, which are detailed in the next section.

Figures

Figure 1
Figure 1. Single-center combined medical and surgical case series of patients with fulminant Clostridioides difficile infection
Figure 2
Figure 2. Mortality in patients with fulminant Clostridioides difficile infection based on treatment modality
Figure 3
Figure 3. Our proposed protocol and patient care algorithm for patients with fulminant Clostridioides difficile infection
See this image and copyright information in PMC

References

    1. Burden of Clostridium difficile infection in the United States. Lessa FC, Mu Y, Bamberg WM, et al. N Engl J Med. 2015;372:825–834. - PMC - PubMed
    1. Understanding the mechanisms of faecal microbiota transplantation. Khoruts A, Sadowsky MJ. Nat Rev Gastroenterol Hepatol. 2016;13:508–516. - PMC - PubMed
    1. Systematic review and meta-analysis of outcomes following emergency surgery for Clostridium difficile colitis. Bhangu A, Nepogodiev D, Gupta A, Torrance A, Singh P. Br J Surg. 2012;99:1501–1513. - PubMed
    1. Clinical management of severe, fulminant, and refractory Clostridioides difficile infection. Cheng YW, Fischer M. Expert Rev Anti Infect Ther. 2020;18:323–333. - PubMed
    1. Fecal microbiota transplantation for clostridium difficile infection: A systematic review. Drekonja D, Reich J, Gezahegn S, et al. Ann Intern Med. 2015;162:630–638. - PubMed

LinkOut - more resources