Intest Res.  2015 Jan;13(1):80-84. 10.5217/ir.2015.13.1.80.

Refractory Clostridium difficile Infection Cured With Fecal Microbiota Transplantation in Vancomycin-Resistant Enterococcus Colonized Patient

• Jang MO
• An JH
• Jung SI
• Park KH

• KMID: 1807380
• DOI: http://doi.org/10.5217/ir.2015.13.1.80

Abstract

The rates and severity of Clostridium difficile infections, including pseudomembranous colitis, have increased markedly. However, there are few effective treatments for refractory or recurrent C. difficile infections and the outcomes are poor. Fecal microbiota transplantation is becoming increasingly accepted as an effective and safe intervention in patients with recurrent disease, likely due to the restoration of a disrupted microbiome. Cure rates of >90% are being consistently reported from multiple centers. We cured a case of severe refractory C. difficile infection with fecal microbiota transplantation in a patient colonized by vancomycin-resistant enterococcus.

Keyword

Clostridium difficile; Fecal microbiota transplantation; Vancomycin-resistant Enterococcus; Enterocolitis, pseudomembranous; Fecal bacteriotherapy

MeSH Terms

Clostridium difficile*
Colon*
Enterococcus*
Enterocolitis, Pseudomembranous
Humans
Microbiota*

Figure

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  Fig. 1 Simple abdomen x-ray, sigmoidoscopy, and CT findings. (A) The initial simple abdomen x-ray showed ileus. (B) Sigmoidoscopy showed diffuse edematous mucosal change with several yellowish plaques. (C) The initial abdominal CT for extension of colitis revealed marked edematous wall thickening and mural enhancement of the entire colonic loop and rectum.

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  Fig. 2 Sigmoidoscopy findings. Follow-up sigmoidoscopy 7 days later revealed more elevated yellowish pseudomembranes with hyperemic, edematous mucosa in the entire sigmoid colon and rectum.

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  Fig. 3 Hospital course of the patient. Monitoring the outcomes of fecal microbiota transplantation, after two fecal microbiota transplantations (arrow), the patient was afebrile and the number of episodes and amount of diarrhea had decreased. PO, by mouth; IV, intravenous.

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  Fig. 4 Simple abdomen x-ray, sigmoidoscopy findings. (A) Follow-up abdomen x-ray showed improvement of ileus. (B) Sigmoidoscopy 10 days after the second fecal microbiota transplantation revealed focal erythematous edematous mucosa with no pseudomembrane.

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