Reports
of FMT in severe and complicated CDI refractory
to
antibiotic therapy remain sparse, and the standard therapy
continues
to be surgical colectomy. However, surgical therapy
accompanied
by modern supportive care is still associated with
∼50%
mortality [19,20]. The prognosis is only marginally better
than
∼75% mortality associated with pseudomembranous enterocolitis
in 1950s, when Eiseman’s team first reported use of fecal
enemas
[5]. Isolated case reports of successful use of FMT in treat-
ment
of severe and complicated CDI suggest that this approach
should
be investigated further [21–25]. Commonly these patients
have
multiple serious co-morbidities and constitute a very challenging
study population. In this situation FMT is introduced during
active
infection when vegetative forms of C. difficile are still present.
Nevertheless,
in our own experience the response to FMT in the
treatment
of active, complicated CDI can be very prompt and measureable
in mere hours [26]. However, we find that sequential
administration
ofFMTisneededtoachievesustainedrecovery[26].