• Nathaniel A Cohen, Dan M Livovsky, Shir Yaakobovitch, Merav Ben Yehoyada, Ronen Ben Ami, Amos Adler, Hanan Guzner-Gur, Eran Goldin, Moshe E Santo, Zamir Halpern, Kalman Paz, and Nitsan Maharshak.
• Department of Internal Medicine B, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
• Isr Med Assoc J. 2016 Oct 1; 18 (10): 594-599.

BackgroundAntibiotic treatment of Clostridium difficile infection (CDI) has a high failure rate. Fecal microbiota transplantation (FMT) has proven very effective in treating these recurrences.ObjectivesTo determine which method of fecal microbiota transplantation (upper or lower gastrointestinal) and which type of donor (a relative or unrelated) is superior.MethodsThis is a retrospective analysis of treatment protocols and outcomes in 22 patients with refractory or recurrent CDI who underwent FMT at two Israeli facilities. Each center used a different donor type, stool preparation and method of delivery. The Tel Aviv Sourasky Medical Center used unrelated fecal donors and frozen stool samples and delivered them primarily (92%) via the lower gastrointestinal (GI) tract. Shaare Zedek Medical Center used fresh donor stool of relatives and delivered them primarily (90%) via the upper GI tract.ResultsFMT had an overall 2 month cure rate of 89%. Patients treated with FMT that was executed through the lower GI tract recovered faster from the infection (1.6 ± 1.08 vs. 2.4 ± 1 days for the upper tract, P = 0.03). The results also showed that patients who received lower GI tract FMTs were more likely to be cured of CDI (100% vs. 75% for upper tract FMTs, P = 0.16). Five patients (22%) died of CDI/FMT-unrelated causes and two (10%) died of CDI/FMT-related causes during the study period.ConclusionsLower GI tract FMT is a safe and effective treatment for refractory and recurrent CDI, and yields quicker results than upper GI tract FMT.

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