The outcome and long-term follow-up of 94 patients with recurrent and refractory Clostridium difficile infection using single to multiple fecal microbiota transplantation via retention enema

  • C. H. Lee
  • J. E. Belanger
  • Z. Kassam
  • M. Smieja
  • D. Higgins
  • G. Broukhanski
  • P. T. Kim


Clostridium difficile infection (CDI) is one of the most frequent causes of healthcare-associated infections, and its rates are also increasing in the community. The management of CDI has become a major challenge, given growing rates of recurrences and failures with standard antibiotic therapy. Mounting evidence suggests that fecal microbiota transplantation (FMT) may be effective; however, as there is a paucity of data with regard to repeat FMT for primary non-response to this treatment, this study examined the outcome of multiple FMTs for recurrent CDI. Case records were reviewed for 94 patients who underwent FMT via retention enema for recurrent or refractory CDI during the period 2008–2012. Demographic information, treatment data, and clinical resolution rates were examined for single FMT and cumulative resolution was assessed for multiple FMTs in the context of ongoing symptoms. The cumulative clinical resolution following four or more FMTs was 86 %. When antibiotic therapy was used between FMTs, the clinical resolution rate increased to 92 %. There were no reported adverse events and no patients who were cured with FMT had further episodes of CDI at 6–24 months follow-up. Multiple FMTs administered through enemas is an effective, safe, and simple therapy for the management of recurrent or refractory CDI.


Clostridium Difficile Infection Fecal Microbiota Transplantation Oral Vancomycin Recurrent Clostridium Difficile Infection Retention Enema 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Guarantor of the article

Christine Lee, MD, FRCPC.

Specific author contributions

Planning, chart reviews, conducting, collecting, drafting, and editing of work were done by Christine Lee. Editing and statistical analysis were done by Peter Kim. Data collection was done by Jane Belanger. Chart reviews and editing were done by Zain Kassam and Marek Smieja.

Financial support

This research was partly support by NSERC and NSF through SAMSI.

Potential competing interests

Christine Lee is the principal investigator for a clinical trial comparing fresh versus frozen-and-thawed fecal transplant for the management of recurrent CDI. She and Peter Kim are advisory board members for Rebiotix Inc.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • C. H. Lee
    • 1
    • 2
  • J. E. Belanger
    • 1
    • 6
  • Z. Kassam
    • 3
    • 4
  • M. Smieja
    • 1
    • 2
  • D. Higgins
    • 2
  • G. Broukhanski
    • 5
  • P. T. Kim
    • 1
    • 6
    • 7
  1. 1.Department of Pathology and Molecular MedicineMcMaster University, St Joseph’s HealthcareHamiltonCanada
  2. 2.Department of MedicineMcMaster University, St Joseph’s HealthcareHamiltonCanada
  3. 3.Division of Gastroenterology, Department of MedicineMcMaster UniversityHamiltonCanada
  4. 4.Harvard School of Public HealthHarvard UniversityBostonUSA
  5. 5.Laboratory Medicine and PathobiologyUniversity of TorontoTorontoCanada
  6. 6.Department of Mathematics and StatisticsUniversity of GuelphGuelphCanada
  7. 7.Statistical and Applied Mathematical Sciences InstituteResearch Triangle ParkUSA

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