Fecal Flora Reconstitution for Recurrent Clostridium difficile Infection: Results and Methodology

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Abstract
Recurrent Clostridium difficile infection (RCDI) is an increasingly common clinical problem without ideal treatment options. Our aim was to evaluate our results using Fecal Flora Reconstitution (FFR), and promulgate our methodology to the GI community to foster its more widespread use in appropriate candidates. FFR, sometimes termed "fecal transplantion" has been shown in numerous reports to be an effective treatment of RCDI, however, most of these studies have small sample sizes and few focus specifically on the methodology used in colonoscopic preparation and delivery of donated stool. Nineteen patients with confirmed multiply recurrent CDI were treated by infusing donor stool through a colonoscope. Out of 19 patients, 18 initially responded to treatment with a single FFR treatment, 1 patient responded after a second FFR infusion. All 19 patients maintained prolonged cured status followed until submission, ranging from 6 months to 5 years. Three patients were presumed reinfected after remaining symptom free for a period spanning from 6 months to 4 years. These patients tested positive for C. difficile after prescription of additional antibiotics for unrelated infections. Fecal Flora Reconstitution is an effective, viable, and simple method of treatment for the difficult to treat patients with RCDI who fail standard therapy.