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News

Duodenal infusion of donor feces vs vancomycin for C. difficile

A study in this week's issue of the New England Journal of Medicine examines the effect of duodenal infusion of donor feces for recurrent Clostridium difficile.

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Recurrent Clostridium difficile infection is difficult to treat, and failure rates for antibiotic therapy are high.

Dr Els van Nood and colleagues studied the effect of duodenal infusion of donor feces in patients with recurrent C. difficile infection.
 
The research team randomly assigned patients to receive 1 of 3 therapies.

Group 1 received an initial vancomycin regimen, followed by bowel lavage and subsequent infusion of a solution of donor feces through a nasoduodenal tube.

Group 2 received a standard vancomycin regimen.

Patients in Group 3 received a standard vancomycin regimen with bowel lavage.

The primary end point was the resolution of diarrhea associated with C. difficile infection without relapse after 10 weeks.
 
The study was stopped after an interim analysis.

Of 16 patients in the infusion group, 81% had resolution of C. difficileľassociated diarrhea after the first infusion.

The 3 remaining patients received a second infusion with feces from a different donor, with resolution in 2 patients.

Resolution of C. difficile infection occurred in 31% of patients receiving vancomycin alone, and in 23% of patients receiving vancomycin with bowel lavage.

No significant differences in adverse events among the 3 study groups were observed except for mild diarrhea, and abdominal cramping in the infusion group on the infusion day.

After donor-feces infusion, patients showed increased fecal bacterial diversity, similar to that in healthy donors, with an increase in Bacteroidetes species and clostridium clusters IV and XIVa, and a decrease in Proteobacteria species.
 
Dr van Nood's team concludes, "The infusion of donor feces was significantly more effective for the treatment of recurrent C. difficile infection than the use of vancomycin."

NEJM 2013; 368: 407-415
01 February 2013

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