Recurrent Clostridium difficile infection treated with home fecal transplantation: a case report

Journal of Medical Case Reports

John Fardy²  Pauline S Duke¹ 

[1] Discipline of Family Medicine, Faculty of Medicine, Memorial University, 300 Prince Phillip Drive, St. John’s, NF A1B 3V6, Canada;Discipline of Medicine, Faculty of Medicine, Memorial University, 300 Prince Phillip Drive, St. John’s, NF A1B 3V6, Canada

关键词: Healthcare resources;    Fecal transplantation;    Clostridium difficile infection;   

Others  :  1180960
DOI  :  10.1186/1752-1947-8-393

 received in 2014-05-14, accepted in 2014-09-17,  发布年份 2014

【 摘 要 】

Introduction

Clostridium difficile infection causes severe diarrhea, abdominal pain and weight loss. A course of metronidazole is the initial treatment; however up to 40% of patients have at least one recurrence. Some patients have recurrent infections requiring further treatment with vancomycin, others need multiple courses of expensive treatment. Fecal transplantation has been proposed as an effective treatment option for patients with recurrences. We report the case of a patient with recurrent Clostridium difficile infection unresponsive to usual treatment and her experience with home fecal transplantation.

Case presentation

A 66-year-old Canadian Caucasian woman presented to her family doctor in December 2012 with a 10-day history of explosive watery diarrhea. She was diagnosed with Clostridium difficile infection and treated with metronidazole. Diarrhea recurred and despite treatment with vancomycin and finally, fidaxomicin, she continued to have recurrent Clostridium difficile infection over the following four months. A formal fecal transplantation program was not available in her home province; therefore home fecal transplantation was performed under supervision by her family physician. This was the first case of fecal transplantation performed in the province and was done outside of a hospital setting. She recovered immediately and has been well for the past year since the procedure.

Conclusions

Home fecal transplantation by rectal enema is a viable, safe and practical option for patients with recurrent Clostridium difficile infection. It is less costly and uses fewer resources than traditional delivery methods through nasogastric tube, upper endoscopy or colonoscopy. Patients and their families and donors need medical supervision through the process of screening, telephone availability during the procedure and medical follow-up. This can be done by family physicians without the need for expensive hospital care and subsequent follow-up.

【 授权许可】

   
2014 Duke and Fardy; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Silverman MS, Davis I, Pillai DR: Success of self-administered home fecal transplantation for chronic Clostridium difficile infection. Clin Gastroenterol Hepatol 2010, 8:471-473.
• [2]Gough E, Shaikh H, Manges A: Systematic review of intestinal microbiota transplantation (fecal bacteriotherapy) for recurrent Clostridium difficile infection. Clin Infect Dis 2011, 53:994-1002.
• [3]Honda H, Dubberke ER: The changing epidemiology of Clostridium difficile infection. Curr Opin Gastroenterol 2014, 30:54-62.
• [4]Kassam Z, Hundal R, Marshall JK, Lee CH: Fecal transplant via retention enema for refractory or recurrent Clostridium difficile infection. Arch Intern Med 2012, 172:191-193.
• [5]Cammarota G, Ianiro G, Gasbarrini A: Fecal microbiota transplantation for the treatment of Clostridium difficile infection: a systematic review. J Clin Gastroenterol 2014, 48:693-702.
• [6]Kassam Z, Lee CH, Yuan Y, Hunt RH: Fecal microbiota transplantation for Clostridium difficile infection: systematic review and meta-analysis. Am J Gastroenterol 2013, 108:500-508.
• [7]McCune VL, Struthers JK, Hawkey PM: Faecal transplantation for the treatment of Clostridium difficile infection: a review. Int J Antimicrob Agents 2014, 43:201-206.