Patients suffering from infection of the bowel with the Gram-positive bacillus Clostridium difficile often have recurrent infections despite antibiotic treatment. In such cases, the transfer of stool from a healthy donor into the patient's bowel is a safe and effective treatment option. This is the conclusion of Stefan Hagel, Andreas Stallmach, Maria Vehreschild, and co-authors and of the members of the German Clinical Microbiome Study Group in their article in the current issue of the Deutsches Ärzteblatt International (Dtsch Arztebl Int 2016; 113: 583-9).
In a retrospective, multicenter, longitudinal observational study, the response rates to fecal microbiota transplantation as a treatment for recurrent C. difficile infection were determined a 30 and 90 days, and adverse events were registered. Primary cure was achieved at 30 days in 101 of 120 patients (84.2%), and at 90 days in 72 of 92 patients (78.3%). These figures improved further after a second microbiota transplantation in 19 of the patients. There were no severe adverse effects or deaths within 30 days of the treatment.
Fecal microbiota transplantation has not been approved by the regulatory authorities and can only be used in Germany as an individual treatment for C. difficile infection if all other treatments have failed. The authors call for more uniform documentation of the clinical efficacy and safety of fecal microbiota transplantation. For better quality assurance, the diverse protocols for patient selection, donor screening, and the processing and application of stool samples are in need of harmonization.
Deutsches Aerzteblatt International