Dramatic reduction in Clostridium difficile ribotype 027-associated mortality with early fecal transplantation by the nasogastric route: a preliminary report

  • J.-C. Lagier
  • M. Delord
  • M. Million
  • P. Parola
  • A. Stein
  • P. Brouqui
  • D. Raoult
Article

Abstract

Clostridium difficile ribotype 027 (CD027)-associated diarrhea preferentially affects elderly patients and causes a high mortality rate. Fecal microbiota transplantation has become an alternative treatment for recurrent C. difficile infections. An outbreak of CD027 infections has occurred in Marseille since March 2013. From March to November 2013, we treated patients using only antibiotics or fecal microbiota transplantation after at least three relapses. Beginning in November 2013, we performed early transplantation using a nasogastric tube during the first week of infection, in combination with antibiotic treatment. Sixty-one patients with a mean age of 84 years were hospitalized, including 42 patients treated only with antibiotics, three with tardive transplantation, and 16 with early transplantation. The patients were comparable in clinical involvement. The global mortality rate was 3/16 (18.75 %) among the patients treated by early transplantation and 29/45 (64.4 %) among the patients only treated by antibiotics or by tardive transplantation (p < 0.01). Among these 45 patients, 23 (51 %) died at day 31, including 17 who died at day 7. Early fecal transplantation was associated with a significantly reduced mortality rate, with only one patient dead at day 31 (6.25 %). In a Cox model, early transplantation was the only independent predictor of survival (hazard ratio 0.18, 95 % confidence interval 0.05–0.61, p = 0.006). Six of the 16 patients (37.5 %) needed a second transplantation before symptom resolution. Early fecal microbiota transplantation in combination with antibiotics should be the first-line treatment for CD027 infections.

Notes

Acknowledgments

This study was funded by IHU Méditerranée Infection.

Conflict of interest

The authors declare that they have no conflict of interest.

Compliance with ethical standards

The authors declare that they have complied with ethical standards with respect to the disclosure of conflict of interest and research involving humans according to French legislation. Informed consents were obtained (see the text for further details).

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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • J.-C. Lagier
    • 1
    • 2
  • M. Delord
    • 2
  • M. Million
    • 1
    • 2
  • P. Parola
    • 1
    • 2
  • A. Stein
    • 1
    • 3
  • P. Brouqui
    • 1
    • 2
  • D. Raoult
    • 1
  1. 1.Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, INSERM 1095MarseilleFrance
  2. 2.IHU Méditerranée Infection, Pôle des Maladies Infectieuses et Tropicales Clinique et Biologique, Service de Maladies Infectieuses et TropicalesCHU Nord, Assistance Publique—Hôpitaux de MarseilleMarseilleFrance
  3. 3.IHU Méditerranée Infection, Pôle des Maladies Infectieuses et Tropicales Clinique et Biologique, Service de Maladies Infectieuses et TropicalesCHU Conception, Assistance Publique—Hôpitaux de MarseilleMarseilleFrance

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