Faecal microbiota transplantation (FMT) has been reported to be effective in treating relapsing of refractory Clostridium difficile infections, although some practical barriers are limiting its widespread use. In this study, our objective was to evaluate the rate of resolution of diarrhea following administration of lyophilized and resolved FMT via a nasogastric (NG) tube. We recruited 19 patients suffered from laboratory-confirmed C. difficile infection. Each of them was treated by lyophilized and resolved inoculum through a NG tube. One participant succumbed following the procedure due to unrelated diseases. Out of 18 cases, 15 patients reportedly experienced a resolution of the symptoms. One patient was treated with another course of antibiotics, and two of the non-responders were successfully retreated with another course of FMT utilizing a lyophilized inoculum. Notably, no significant adverse activities were observed. In accordance to our clinical experiences, a patient will likely benefit from FMT treatment including lyophilized inoculum.
Hall, I. C., O’Toole, E.: Intestinal flora in newborn infants: With a description of a new pathogenic anaerobe, Bacillus difficile. Am J Dis Child 49, 390 (1935).
Larson, H. E., Price, A. B., Honour, P., Borriello, S. P.: Clostridium difficile and the aetiology of pseudomembranous colitis. Lancet 1, 1063–1067 (1978).
Carroll, K. C., Bartlett, J. G.: Biology of Clostridium difficile: Implications for epidemiology and diagnosis. Annu Rev Microbiol 65, 501–521 (2011).
O’Donoghue, C., Kyne, L.: Update on Clostridium difficile infection. Curr Opin Gastroenterol 27, 38–47 (2011).
Lo Vecchio, A., Zacur, G. M.: Clostridium difficile infection: An update on epidemiology, risk factors, and therapeutic options. Curr Opin Gastroenterol 28, 1–9 (2012).
Pepin, J., Valiquette, L., Gagnon, S., Routhier, S., Brazeau, I.: Outcomes of Clostridium difficile-associated disease treated with metronidazole or vancomycin before and after the emergence of NAP1/027. Am J Gastroenterol 102, 2781–2788 (2007).
Petrella, L. A., Sambol, S. P., Cheknis, A., Nagaro, K., Kean, Y., Sears, P.S., Babakhani, F., Johnson, S., Gerding, D. N.: Decreased cure and increased recurrence rates for Clostridium difficile infection caused by the epidemic C. difficile BI strain. Clin Infect Dis 55, 351–357 (2012).
Austin, M., Mellow, M., Tierney, W. M.: Fecal microbiota transplantation in the treatment of Clostridium difficile infections. Am J Med 127, 479–483 (2011).
Youngster, I., Sauk, J., Pindar, C., Wilson, R. G., Kaplan, J. L., Smith, M. B., Alm, E. J., Gevers, D., Russell, G. H., Hohmann, E. L.: Fecal microbiota transplant for relapsing Clostridium difficile infection using a frozen inoculum from unrelated donors: A randomized, open-label, controlled pilot study. Clin Infect Dis 58, 1515–1522 (2011).
van Nood, E., Vrieze, A., Nieuwdorp, M., Fuentes, S., Zoetendal, E. G., de Vos, W. M., Visser, C. E., Kuijper, E. J., Bartelsman, J. F., Tijssen, J. G., Speelman, P., Dijkgraaf, M. G., Keller, J. J.: Duodenal infusion of donor feces for recurrent Clostridium difficile. N Engl J Med 368, 407–415 (2013).
Debast, S. B., Bauer, M. P., Kuijper, E. J., European Society of Clinical Microbiology and Infectious Diseases: European Society of Clinical Microbiology and Infectious Diseases update of the treatment guidance document for Clostridium difficile infection. Clin Microbiol Infect 20, 1–26 (2014).
Surawicz, C. M., Brandt, L. J., Binion, D. G., Ananthakrishnan, A. N., Curry, S. R., Gilligan, P. H., McFarland, L. V., Mellow, M., Zuckerbraun, B. S.: Guidelines for diagnosis, treatment, and prevention of Clostridium difficile infections. Am J Gastroenterol 108, 478–498 (2013).
Hamilton, M., Weingardenv, A., Sadowsky, M., Khoruts, A.: Standardized frozen preparation for transplantation of fecal microbiota for recurrent Clostridium difficile infection. Am J Gastroenterol 107, 761–767 (2012).
Lee, C. H, Steiner, T., Petrof, E. O., Smieja, M., Roscoe, D., Nematallah, A., Weese, J. S., Collins, S., Moayyedi, P., Crowther, M., Ropeleski, M. J, Jayaratne, P., Higgins, D., Li, Y., Rau, N. V, Kim, P. T.: Frozen vs fresh fecal microbiota transplantation and clinical resolution of diarrhea in patients with recurrent Clostridium difficile infection: A randomized clinical trial. JAMA 315, 142–149 (2016).
Festi, D., Schiumerini, R., Birtolo, C., Marzi, L., Montrone, L., Scaioli, E., Di Biase, A. R., Colecchia, A.: Gut microbiota and its pathophysiology in disease paradigms. Dig Dis 29, 518–552 (2011).
Ghoshal, U., Shukla, R., Ghoshal, U., Gwee, K. A., Ng, S. C., Quigley, E. M.: The gut microbiota and irritable bowel syndrome: Friend or foe? Int J Inflamm 2012, 151085 (2012).
Rholke, F., Stollman, F.: Fecal microbiota transplantation in relapsing Clostridium difficile infection. Ther Adv Gastroenterol 516, 403–420 (2012).
Gough, E., Shaikh, H., Manges, A.: Systematic review of intestinal microbiota transplantation (fecal bacteriotherapy) for recurrent Clostridium difficile infection. Clin Infect Dis 53, 994–1002 (2011).
Borody, T. J., Warren, E. F., Leis, M. S., Surace, R., Ashman, O., Siarakas, S.: Bacteriotherapy using fecal flora toying with human motions. J Clin Gastroenterol 38, 475–483 (2004).
Gustaffson, A., Lund-Tonnensen, S., Berstad, A., Midtvedt, T., Norin, E.: Faecal short-chain fatty acids in patients with antibiotic associated diarrhea, before and after fecal enema treatment. Scand J Gastroeneterol 33, 721–727 (1998).
Gustaffson, A., Berstad, A., Lund-Tonnensen, S., Midtvedt, T., Norin, E.: The effect of fecal enema on five microflora associated characteristics in patients with antibiotic associated diarrhea. Scand J Gastroenterol 34, 580–586 (1999).
Aas, J., Gessert, C., Bakken, J.: Recurrent Clostridium difficile colitis: Case series involving 18 patients treated with donor stool administered via a nasogastric tube. Clin Infect Dis 36, 580–585 (2013).
Garborg, K., Waagsbo, B., Stallemo, A., Matre, J., Sundøy, A.: Results of faecal donor instillation therapy for recurrent Clostridium difficile-associated diarrhoea. Scand J Infect Dis 42, 857–861 (2010).
Nieuwdorp, M., van Nood, E., Speelman, P., van Heukelem, H. A., Jansen, J. M., Visser, C. E., Kuijper, E. J., Bartelsman, J. F., Keller, J. J.: Treatment of recurrent Clostridium difficile-associated diarrhoea with a suspension of donor faeces. Ned Tijdschr Geneeskd 152, 1927–1932 (2008).
Rubin, T., Gessert, C., Aas, J.: Stool transplantation for older patients with Clostridium difficile infection. J Am Geriatr Soc 57, 2386 (2009).
Vigvari, Sz., Nemes, Zs., Vincze, A., Solt, J., Sipos, D., Feiszt, Z., Kappéter, A., Kovács, B., Péterfi, Z.: Experience with fecal microbiota transplantation in the treatment of Clostridium difficile infection. Orv Hetil 155, 1758–1762 (2014).
Brandt, L., Aroniadis, O., Mellow, M., Kanatzar, A., Kelly, C., Park, T., Stollman, N., Rohlke, F., Surawicz, C.: Long-term follow-up of colonoscopic fecal microbiota transplant (FMT) for recurrent C. difficile infection (RCDI). Am J Gastroenterol 107, 1079–1087 (2012).
Bakken, J. S., Borody, T., Brandt, L. J., Brill, J. V., Demarco, D. C., Franzos, M. A., Kelly, C., Khoruts, A., Louie, T., Martinelli, L. P., Moore, T. A., Russell, G., Surawicz, C., Fecal Microbiota Transplantation Workgroup: Treating Clostridium difficile infection with fecal microbiota transplantation. Clin Gastroenterol Hepatol 12, 1044–1049 (2011).
Cohen, S. H., Gerding, D. N., Johnson, S., Kelly, C. P., Loo, V. G., McDonald, L. C., Pepin, J., Wilcox, M., Society for Healthcare Epidemiology of America, Infectious Diseases Society of America: Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA). Infect Control Hosp Epidemiol 31, 431–455 (2010).
Kupletskaya, M. B., Netrusov, A. I.: Viability of lyophilized microorganisms after 50-year storage. Microbiology 80, 850–853 (2011).
Antheunisse, J. Viability of lyophilized microorganisms after storage. Antonie van Leeuwenhoek 39, 243–248 (1973).