Applied Evidence

It’s time to rethink your approach to C diff infection

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When meds fail, consider a fecal microbiota transplant

Another important change in the IDSA guidelines for CDI management is the strong recommendation for fecal microbiota transplantation (FMT) in patients with multiple recurrences of CDI for whom appropriate antibiotic treatment courses have failed.11,25 The goal of FMT is to “normalize” an abnormal gut microbiome by transplanting donor stool into a recipient.26

FMT has been shown to be highly effective in 5 randomized clinical trials conducted since 2013, with CDI cure rates between 85% and 94%.11 This rate of cure is particularly impressive given that the studies only included patients with refractory CDI.

Patients with recurrent CDI who may be candidates for FMT should be referred to a center or specialist with experience in FMT. These transplants can be expensive because of the screening process involved in obtaining donor samples. (Historically, a single FMT has cost $3000-$5000, and it is seldom covered by insurance.27) The emergence of universal stool banks offers a streamlined solution to this process.26

Metronidazole should only be used in the treatment of C difficile infection as a last-resort medication because of cost or insurance coverage.

Fresh or frozen stool is considered equally effective in treating refractory CDI.26 Oral capsule and freeze-dried stool formulations have been studied, but their use is considered investigational at this time.26

Delivery via colonoscopy to the right colon is the preferred route of infusion; however, delivery via enema or nasogastric, nasojejunal, or nasoduodenal infusion can be considered as well.26

Continue to: In preparing for stool transplantation...

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