Premium
Fecal Transplantation for Recurrent C lostridium difficile Infection in Older Adults: A Review
Author(s) -
Burke Kristin E.,
Lamont John T.
Publication year - 2013
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.12378
Subject(s) - medicine , fecal bacteriotherapy , transplantation , clostridium difficile , feces , randomized controlled trial , surgery , antibiotics , microbiology and biotechnology , biology
Recurrent C lostridium difficile infection ( CDI ) is a common nosocomial infection that has a large effect on morbidity and quality of life in older adults in hospitals and long‐term care facilities. Because antibiotics are often unsuccessful in curing this disease, fecal transplantation has emerged as a second‐line therapy for treatment of recurrent CDI . A comprehensive literature search of P ubMed, E mbase, and Web of Science regarding fecal transplantation for CDI was performed to further evaluate the efficacy and side effects of this promising therapy in older adults. Data were extracted from 10 published articles from 1984 to the present that met inclusion criteria , including nine open‐label reports and one randomized controlled trial. Baseline characteristics and outcomes of individuals undergoing fecal transplantation and effects of fecal transplantation on the fecal microflora were reviewed. Methods of fecal transplantation and donor selection were reviewed. Fecal transplantation was performed in 115 individuals aged 60 to 101, with a female predominance. CDI cure was achieved in 103 (89.6%) individuals over a follow‐up period of 2 months to 5 years (mean 5.9 months). There was no significant difference in cure rate between older and younger participants in included studies. Most failed transplantation occurred in individuals infected with the aggressive NAP 1/027 strain of C . difficile . Microbiological studies of fecal biodiversity before and after fecal transplantation demonstrated greater bacterial diversity and shift in flora species to resemble donor flora after transplantation that correlated with clinical remission. Fecal transplantation provides a safe and durable cure for older adults with recurrent CDI .