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Fecal Transplantation using a Nasoenteric Tube during an Initial Episode of Severe Clostridium difficile Infection.

Jeon YD, Hong N, Kim JH, Park SH, Kim SB, Song IJ, Ann HW, Ahn JY, Kim SB, Ku NS, Lee K, Yong D, Kim JM, Choi JY - Infect Chemother (2016)

Bottom Line: The incidence of Clostridium difficile infection is increasing worldwide, and its severity and resulting mortality are also on the rise.Metronidazole and oral vancomycin remain the treatments of choice, but there are concerns about treatment failure and the appearance of resistant strains.Furthermore, antibiotic therapy results in recurrence rates of at least 20%.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT
The incidence of Clostridium difficile infection is increasing worldwide, and its severity and resulting mortality are also on the rise. Metronidazole and oral vancomycin remain the treatments of choice, but there are concerns about treatment failure and the appearance of resistant strains. Furthermore, antibiotic therapy results in recurrence rates of at least 20%. Fecal transplantation may be a feasible treatment option for recurrent C. difficile infection; moreover, it may be an early treatment option for severe C. difficile infection. We report a case of severe C. difficile infection treated with fecal transplantation using a nasoenteric tube during an initial episode. This is the first reported case of fecal transplantation using a nasoenteric tube during an initial episode of C. difficile infection in Korea.

No MeSH data available.


Related in: MedlinePlus

Method of fecal transplantation. (A) The tip of the nasoenteric tube was placed at the third portion of the duodenum by esophagogastroduodenoscopy. (B, C) Fifty grams stool collected from the donor was diluted with 500 mL normal saline, and the supernatant was filtered out with gauze. This solution was placed into the feeding bag and infused through a nasoenteric tube for 30 minutes.
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Figure 1: Method of fecal transplantation. (A) The tip of the nasoenteric tube was placed at the third portion of the duodenum by esophagogastroduodenoscopy. (B, C) Fifty grams stool collected from the donor was diluted with 500 mL normal saline, and the supernatant was filtered out with gauze. This solution was placed into the feeding bag and infused through a nasoenteric tube for 30 minutes.

Mentions: On the 59th hospital day, during conservative treatment for infective spondylitis, the patient developed a fever of 38.1℃ and diarrhea; his blood pressure was 89/58 mmHg. Due to suspicion of C. difficile infection, oral 500 mg metronidazole was given every 8 hours empirically. Stool C. difficile toxin A/B and culture were confirmed to be positive. On the 60th hospital day, laboratory results revealed a white blood cell count of 39,560/mm3 (neutrophils, 89.4%; lymphocytes, 6.2%; monocytes, 2.8%), hemoglobin level of 11.8 g/dL, platelet count of 292,000/mm3, BUN/Cr of 18.0/0.65 mg/dL, and albumin level of 1.8 g/dL. On the 61st hospital day, oral metronidazole was switched to 250 mg oral vancomycin every 6 hours due to increased severity of diarrhea and the detection of paralytic ileus on abdominal X-ray despite administration of oral metronidazole. Intravenous metronidazole (every 8 hours) and vancomycin enema 500 mg (every 6 hours) were also added to the treatment course. Unfortunately, symptoms did not improve, and disseminated intravascular coagulation (DIC) progressed although leukocytosis was improved. On the 74th hospital day, laboratory results showed a white blood cell count of 3,240/mm3 (neutrophils, 71.0%; lymphocytes, 20.1%; monocytes, 6.8%), a hemoglobin level of 7.8 g/dL, platelet count of 67,000/mm3, PT/aPTT of 22.6 sec/65.4 sec, albumin level of 1.9 g/dL and C-reactive protein level of 77.2 mg/L. Fecal transplantation was recommended and the patient consented to the procedure. The patient's wife, who had no relevant medical history and no symptoms of acute disease, was selected as the donor. On the 75th hospital day, fecal transplantation was performed. The tip of a nasoenteric tube was placed in the third portion of the duodenum by EGD. Fifty grams of stool collected from the donor was diluted with 500 mL normal saline and the supernatant was filtered out with gauze. This solution was placed into the feeding bag and infused through a nasoenteric tube for 30 minutes (Fig. 1).


Fecal Transplantation using a Nasoenteric Tube during an Initial Episode of Severe Clostridium difficile Infection.

Jeon YD, Hong N, Kim JH, Park SH, Kim SB, Song IJ, Ann HW, Ahn JY, Kim SB, Ku NS, Lee K, Yong D, Kim JM, Choi JY - Infect Chemother (2016)

Method of fecal transplantation. (A) The tip of the nasoenteric tube was placed at the third portion of the duodenum by esophagogastroduodenoscopy. (B, C) Fifty grams stool collected from the donor was diluted with 500 mL normal saline, and the supernatant was filtered out with gauze. This solution was placed into the feeding bag and infused through a nasoenteric tube for 30 minutes.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4835432&req=5

Figure 1: Method of fecal transplantation. (A) The tip of the nasoenteric tube was placed at the third portion of the duodenum by esophagogastroduodenoscopy. (B, C) Fifty grams stool collected from the donor was diluted with 500 mL normal saline, and the supernatant was filtered out with gauze. This solution was placed into the feeding bag and infused through a nasoenteric tube for 30 minutes.
Mentions: On the 59th hospital day, during conservative treatment for infective spondylitis, the patient developed a fever of 38.1℃ and diarrhea; his blood pressure was 89/58 mmHg. Due to suspicion of C. difficile infection, oral 500 mg metronidazole was given every 8 hours empirically. Stool C. difficile toxin A/B and culture were confirmed to be positive. On the 60th hospital day, laboratory results revealed a white blood cell count of 39,560/mm3 (neutrophils, 89.4%; lymphocytes, 6.2%; monocytes, 2.8%), hemoglobin level of 11.8 g/dL, platelet count of 292,000/mm3, BUN/Cr of 18.0/0.65 mg/dL, and albumin level of 1.8 g/dL. On the 61st hospital day, oral metronidazole was switched to 250 mg oral vancomycin every 6 hours due to increased severity of diarrhea and the detection of paralytic ileus on abdominal X-ray despite administration of oral metronidazole. Intravenous metronidazole (every 8 hours) and vancomycin enema 500 mg (every 6 hours) were also added to the treatment course. Unfortunately, symptoms did not improve, and disseminated intravascular coagulation (DIC) progressed although leukocytosis was improved. On the 74th hospital day, laboratory results showed a white blood cell count of 3,240/mm3 (neutrophils, 71.0%; lymphocytes, 20.1%; monocytes, 6.8%), a hemoglobin level of 7.8 g/dL, platelet count of 67,000/mm3, PT/aPTT of 22.6 sec/65.4 sec, albumin level of 1.9 g/dL and C-reactive protein level of 77.2 mg/L. Fecal transplantation was recommended and the patient consented to the procedure. The patient's wife, who had no relevant medical history and no symptoms of acute disease, was selected as the donor. On the 75th hospital day, fecal transplantation was performed. The tip of a nasoenteric tube was placed in the third portion of the duodenum by EGD. Fifty grams of stool collected from the donor was diluted with 500 mL normal saline and the supernatant was filtered out with gauze. This solution was placed into the feeding bag and infused through a nasoenteric tube for 30 minutes (Fig. 1).

Bottom Line: The incidence of Clostridium difficile infection is increasing worldwide, and its severity and resulting mortality are also on the rise.Metronidazole and oral vancomycin remain the treatments of choice, but there are concerns about treatment failure and the appearance of resistant strains.Furthermore, antibiotic therapy results in recurrence rates of at least 20%.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT
The incidence of Clostridium difficile infection is increasing worldwide, and its severity and resulting mortality are also on the rise. Metronidazole and oral vancomycin remain the treatments of choice, but there are concerns about treatment failure and the appearance of resistant strains. Furthermore, antibiotic therapy results in recurrence rates of at least 20%. Fecal transplantation may be a feasible treatment option for recurrent C. difficile infection; moreover, it may be an early treatment option for severe C. difficile infection. We report a case of severe C. difficile infection treated with fecal transplantation using a nasoenteric tube during an initial episode. This is the first reported case of fecal transplantation using a nasoenteric tube during an initial episode of C. difficile infection in Korea.

No MeSH data available.


Related in: MedlinePlus