Correspondence: F. Emanuelsson, Department of Internal Medicine, Skaraborgs Hospital Skövde, SE-54185 Skövde, Sweden. E-mail: frida.k.emanuelsson@ gmail.com (Received 27 April 2013; accepted 16 October 2013) Scandinavian Journal of Infectious Diseases, 2014; 46: 89–97 ISSN 0036-5548 print/ISSN 1651-1980 online © 2014 Informa Healthcare DOI: 10.3109/00365548.2013.858181 ORIGINAL ARTICLE Faecal microbiota transplantation and bacteriotherapy for recurrent Clostridium difficile infection: A retrospective evaluation of 31 patients FRIDA EMANUELSSON 1 , BERNDT E. B. CLAESSON 2 , LARS LJUNGSTRÖM 3 , MICHAEL TVEDE 4 & KJELL-ARNE UNG 1 From the 1 Department of Internal Medicine, Skaraborgs Hospital Skövde, Sweden, 2 Department of Microbiology, Unilabs AB, Skaraborgs Hospital Skövde, Sweden, 3 Department of Infectious Diseases, Skaraborgs Hospital Skövde, Sweden, and 4 Department of Clinical Microbiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark Abstract Background: Recurrent Clostridium difficile infection (CDI) is a significant problem due to its increased incidence and severity. Failure rates for standard antibiotic therapies are high. In our hospital, faecal microbiota transplantation (FMT), or instillation of a culture mixture of known enteric bacteria in saline as rectal bacteriotherapy (RBT), has long been used as ‘rescue therapy’ in patients with recurrent disease, in whom repeated courses of standard antibiotic treatment have failed. We wanted to evaluate the effectiveness of FMT and RBT for recurrent CDI. Methods: The records of 31 patients treated with either FMT or RBT for recurrent CDI were reviewed retrospectively. FMT was based on faecal donation by a close relative and RBT on a defined saline mixture of 10 individually cultured enteric bacterial strains originally isolated from healthy persons. Both types of instillation were carried out through a rectal catheter. FMT (500 ml) was given as 1 installation. RBT (200 ml) was given as 2 or 3 installations with an interval of 2 days between courses. Treatment success was defined as a sustained loss of symptoms and discontinuation of diarrhoea within 3 days. Results: Of 31 patients, 23 (74%) responded successfully to the treatment: 16 of 23 (70%) receiving FMT and 7 of 8 (88%) receiving RBT. Conclusion: We found FMT to be effective in patients with recurrent CDI. RBT based on a predefined bacterial suspension was as effective as or better than FMT based on faecal donation; however, multiple installations may be needed. Keywords: Clostridium difficile infection, faecal microbiota transplantation, gut microbiota, rectal bacteriotherapy Introduction Clostridium difficile infection (CDI) is a common cause of diarrhoea. The condition is often preceded by treatment with antibiotics, which is thought to alter the intestinal bacterial flora and thereby reduce the resistance of the innate colonization to opportu- nistic pathogens [1–5]. Symptoms may range from mild diarrhoea to fulminant pseudomembranous colitis, toxic megacolon, intestinal perforation, and death [1,2,5]. Over recent years, the incidence of CDI has been increasing in both Europe and the USA, and the condition is increasingly more aggressive and refrac- tory to standard treatment. In particular, among older patients and in patients with co-morbidities the consequences may be substantial and lead to prolonged hospitalization and increased morbidity and mortality [2,4,6,7]. The same trend has been seen in Sweden, where the number of patients with diagnosed CDI has increased by 60% over the last decade. During the same period, the number of death certificates indicating CDI as a primary or contributory cause of death has increased by about 50% [8]. The exact incidence of CDI has been uncertain due to variations in testing frequencies and diagnostic methods (enzyme immunoassay (EIA), cytotoxin assay, or polymerase chain reaction (PCR)). However, in 2009 a Swedish national data Scand J Infect Dis Downloaded from informahealthcare.com by Vastra Gotalandsregionen on 05/07/15 For personal use only.