Fecal Microbiota Transplant in Severe/Complicated Clostridium difficile Infection: A Retrospective Case Series.

Clostridium difficile infection (CDI) is the most common hospital-acquired infection in the United States. Fecal microbiota transplant (FMT) has become a highly efficacious therapy for recurrent mild/moderate disease; however, the efficacy and optimal delivery method in severe/complicated disease is unknown. A retrospective chart review was performed for all FMT recipients at the University of Alabama at Birmingham. Those with severe/complicated disease were isolated and their clinical course documented via chart review and phone calls. Eight patients with severe/complicated CDI who received FMT via both lower and/or upper routes were documented. Six experienced eventual cure, 2 died, with 1 death attributed to CDI, the other to another nosocomial infection. Fecal microbiota transplant is a reasonable option and should be considered in patients who are not surgical candidates. If lower endoscopy is not possible, delivery of FMT via nasogastric tube should also be considered. More studies comparing the efficacy of these routes are needed. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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