Fecal Microbiota Transplantation After Oral Vancomycin for Recurrent Clostridium difficile Infection

Purpose Clostridium difficile infection (CDI) is one of the most common hospital-acquired infections in developed countries. Since 2000, there has been a significant increase in the incidence and severity of CDI. Treating recurrent CDI (rCDI) is challenging because the risk of recurrence increases with each subsequent episode. Several studies have demonstrated the benefit of fecal microbiota transplantation (FMT) in patients with rCDI with a cure rate ranging between 80% and 100%. The aims of this study were to review the FMT procedure and to identify the success rate of using 2-week oral vancomycin treatment before the FMT. Methods We performed a retrospective chart review for patients with rCDI who underwent an FMT procedure between 2014 and 2017. This study included patients who were diagnosed with rCDI and received 2-week oral vancomycin treatment before the FMT at Piedmont Columbus Regional Hospital. Results During the study period, 31 patients underwent 34 FMT procedures for rCDI. Twenty-nine patients were included in the study. Two patients (6.9%) had confirmed recurrence within 8 weeks after FMT, and 27 patients (93.1%) were considered treatment successes. No adverse events were noted. Both patients with FMT failures were offered treatment with a repeat FMT. Thirty-nine percent had mild to moderate rCDI. Most patients (69%) received upper FMT and 58.6% had fresh stool transplanted. Conclusions Fecal microbiota transplantation preceded by a standard 2-week vancomycin regimen for the treatment of patients with rCDI seems to be safe and effective. Further research is needed to explore optimal pretreatment regimens before the FMT to prevent FMT failure.