2. Fecal bacteriotherapy
Fecal bacteriotherapy refers to the process of instilling a liquid
suspension of stool from a healthy donor into the gastrointestinal
tract. The stool sample may be collected from a patient household
contact or an unrelated donor on the day of use. Prior to collection,
the sample donor has customarily been screened for potentially
contagious infectious agents [10]. After collection, the stool sample
is processed in the clinical laboratory into a liquid suspension, and
is subsequently instilled into the upper GI tract through a nasoduodenal
catheter or into the colon through a colonoscope or
a retention enema catheter.
Fecal enemas have been used as treatment for a variety of
gastrointestinal diseases, including inflammatory bowel disease
[21], chronic constipation [22], and pouchitis [23]. A Medline search
using the search words pseudomembranous enterocolitis and
C. difficile associated diarrhea resulted in 13 published reports about
fecal instillation therapy for recurrent episodes of CDI (Table 1).
Eiseman and coworkers were the first investigators to report the
successful use of fecal enemas in the management of four patients
with pseudomembranous enterocolitis (PEC) [24]. Three of their
patients had recently undergone major abdominal surgery and
almost died before the fecal enemas were employed. More than 20
years later Bowden et al. successfully resolved PEC in 13 of 16
surgical patients (81%) by administering stool collected from inhouse
family members or healthy medical students or hospital
residents [25]. Two of the 16 patients received their fecal instillation
via an infusion catheter with tip placement in the proximal jejunum;
the rest of the patients were given fecal enemas. Three (19%) of the
patients died, but two of these patients died of unrelated illnesses.
Tvede and Rask-Madsen successfully treated 6 patients with RCDI in