Thursday, January 15, 2015

C. Difficile procedure for cure messy but successful

Wed Jan 14, 2015 7:51 pm (PST) . 

Cure Rates Remain High With Fecal Transplant for C difficile Pam Harrison 
October 20, 2014 Fecal Transplant Cost Effective for Recurrent C difficile 
Microbiome Opens Door to Brave New World of Therapeutics. Microbiome technology is more accurate than current diagnostic standards and may lead to more effective interventions. 
C difficile: Synthetic Stool Substitute Clears Infection. 
In a proof-of-principle study, a mix of fecal bacteria repopulated the gut and successfully ended bouts of recurrent antibiotic-resistant Clostridium difficile. 

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PHILADEPHIA — Both initial and sustained responses to fecal microbiota transplant (FMT) for the treatment of refractory C difficile infection remain high out to 18 months' follow-up, provided patients do not require antibiotics for the treatment of an unrelated infection, new research shows. 
"FMT is a well-established and effective option in treating C difficile colitis, especially if it is recurrent or refractory to antibiotics, but we don't have a lot of data in terms of long-term outcomes," Daniel Greenwald, MD, internal medicine resident, Lahey Hospital and Medical Center, Burlington, Massachusetts, told Medscape Medical News in advance of his presentation at the American College of Gastroenterology (ACG) 2014 Annual Scientific Meeting. 

"We looked at a very sick cohort of patients, in that they had either recurrent or refractory C difficile, and we saw a 91.4% primary response rate at 3 months, an 86.2% response rate at 6 months, and an 80.5% response rate at 18 months, which I think is very telling of the effectiveness of FMT, even in sick patients who had failed primary, secondary, and in some cases, tertiary treatment options with antibiotics.
The researchers looked at 58 patients who had previously undergone FMT for recurrent or refractory C difficile infection. During the 18-month follow-up period, they observed that patients with comorbid gastrointestinal illnesses such as celiac disease were more likely to have a recurrent episode of C difficile. 

We looked at a very sick cohort of patients, in that they had either recurrent or refractory C difficile, and we saw a 91.4% primary response rate. Dr Daniel Greenwald  

They also found that in patients who did not have a sustained treatment response to FMT, there was a coincident use of antibiotic therapy after treatment for other conditions. A large percentage of these patients also happened to be on pretransplant immunosuppressive therapy, both well-established independent risk factors associated with susceptibility to C difficile. 

In contrast, patients who took probiotics prior to receiving FMT were more likely to be disease-free at follow-up than patients who had relapsed (P = .0186). 

"Recurrent C difficile is typically seen in patients who need antibiotics for some other condition down the road, so I think overall, this study just adds more data to the experience of the efficacy of FMT." 
In a separate study evaluating safety outcomes after FMT, 45 patients with refractory or recurrent C difficile infection who had received treatment were prospectively followed. Symptoms and adverse events were assessed at multiple time points, including at 6 months after FMT. 

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