Christina M. Surawicz, MD
Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-0609.
Corresponding Author: Christina M. Surawicz, MD, Harborview Medical Center, Box 359773, 325 9th Avenue, Seattle, WA 98104; e-mail, email@example.com.
Surawicz CM. Fecal Microbiota Transplantation: What We Know and What We Need to Know. Ann Intern Med. 2015;162:662-663. doi: 10.7326/M15-0609
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Published: Ann Intern Med. 2015;162(9):662-663.
Recurrent Clostridium difficile infection (CDI) is the recurrence of infection and symptoms after successful initial therapy for C. difficile with resolution of symptoms. The risk for a first recurrence is 10% to 20%, but the rate increases to 40% to 60% after 1 recurrence. Recurrent CDI is difficult to treat, even with pulsed antibiotic regimens and probiotics. Patients who have several recurrences become debilitated and discouraged, and some believe that they may never get rid of the infection. Fecal microbiota transplantation (FMT) has emerged as an excellent therapy for these patients when all other options are unsuccessful.
Fecal microbiota transplantation is the term used to describe delivery of stool from a healthy donor into a patient via enema, colonoscopy, or upper gastrointestinal tract. Since 2000, many published case reports and case-series studies of FMT have reported success rates of 83% to 90%. The landmark randomized, controlled trial (RCT) published in 2013 demonstrated the efficacy of FMT via the nasoduodenal route in patients with recurrent CDI; the study was stopped early because of the effectiveness of FMT compared with standard vancomycin therapy (1). Practice guidelines from both the American College of Gastroenterology and European Society of Clinical Microbiology and Infectious Diseases now recommend FMT for recurrent CDI (2, 3). In this issue, Drekonja and colleagues (4) offer a new systematic review of FMT, incorporating the 2 published RCTs. It gives us several important insights.
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Gastroenterology/Hepatology, Infectious Disease, Pulmonary/Critical Care, Inflammatory Bowel Disease, Colonoscopy/Sigmoidoscopy.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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