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 Table of Contents  
Year : 2013  |  Volume : 5  |  Issue : 6  |  Page : 339-343

Fecal transplantation for the treatment of recurrent Clostridium difficile infection

1 Department of Medicine, Brockton Hospital, Brockton, Massachusetts, USA
2 Westchester Medical Center, New York Medical College, Valhalla, New York, USA

Date of Web Publication28-Jun-2013

Correspondence Address:
Zeid Karadsheh
257 Northampton St. Unit 507, Boston, Massachusetts 02118
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1947-2714.114163

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Clostridium difficile infection (CDI) is currently a leading cause of antibiotic and health care-related diarrhea. The incidence and the severity of CDI-related diarrhea have increased dramatically in the USA and Europe in the past few decades. The emergence of multidrug-resistant hypervirulent strains of C. difficile has led to an increase in mortality. Fecal microbiota transplantation (FMT) (also known as fecal bacteriotherapy) has been utilized sporadically since the 1950s; and currently, the interest in using FMT has grown again in the past few years for the treatment of CDI and other chronic gastrointestinal diseases. FMT has shown to be effective, cheap, and has very few side effects. It is believed to manipulate and restore the gut microbiota, and therefore enhances the growth of "healthy" bacteria that break the cycle of recurrent CDI. This article focus on the recent case reports on FMT, and general approach to patients undergoing this therapy. Data were obtained through a literature search via PubMed and Google.

Keywords: Clostridium difficile infection, Fecal transplantation, Stool transplantation

How to cite this article:
Karadsheh Z, Sule S. Fecal transplantation for the treatment of recurrent Clostridium difficile infection. North Am J Med Sci 2013;5:339-43

How to cite this URL:
Karadsheh Z, Sule S. Fecal transplantation for the treatment of recurrent Clostridium difficile infection. North Am J Med Sci [serial online] 2013 [cited 2022 Oct 6];5:339-43. Available from: https://www.najms.org/text.asp?2013/5/6/339/114163

  Introduction Top

Clostridium difficile infection (CDI) is the leading cause of antibiotic and nosocomial-related diarrhea. [1] CDI cost more than $3.2 billion in the US between 2000-2002, [2] and this number continues to rise. This rise is accompanied by increase rates of colectomy (1.2 per 1000 in 1993 to 3.4 per 1000 in 2003) and mortality (case fatality 7.84% in 1993 to 9.26% in 2003). [3] CDI has also become more severe, more refractory to standard therapy, and more likely to relapse. [4],[5] One main reason for this growing problem is the emergence of newer, more virulent, and antibiotic-resistant strains including (NAP/BI/027) among others. [4],[6]

C. difficile is a gram-positive, spore-forming bacillus that accounts for approximately 15-20% of antibiotic-related diarrhea. [7] It is shed in the feces and spread through the fecal-oral route. Ingesting the organism or its spores transmit the infection between patients. CDI is usually transmitted between patients indirectly either through contaminated hands of health care workers or via contaminated environmental surfaces. [7]

  Risk Factors Top

The main cause of CDI is the use of antibiotics; fluoroquinolones are more associated with CDI than other antibiotics including clindamycin and b-lactams. [8],[9],[10] The risk increases with duration and dose of antibiotics. [11] Additional risk factors include advanced age (older than 65 years), longer hospital stay, increased numbers of morbidities, taking immunosuppressive medications or chemotherapy, recent gastrointestinal (GI) surgery, inflammatory bowel disease, and history of CDI in the past. Recently, proton pump inhibitors are also believed to increase the risk of CDI, possibly by gastric acid suppression. [12],[13],[14],[15],[16],[17]

  Clinical Presentation Top

Most patients present with foul-smelling watery diarrhea; however, patients may present with abdominal pain, fever, nausea and vomiting, decreased appetite and elevated white count. [18] In some cases, toxic megacolon can occur, and up to 20% of cases, patients may present with ileus and abdominal distention. [19] In severe or fulminant CDI, patients may exhibit signs of systemic inflammatory response including leukocytosis, hypotension, increase serum lactic acid level, acute renal failure, and respiratory failure. [20],[21],[22]

  Standard Treatment Top

Removal of the offending antibiotic should be the first step in treating CDI, current guidelines from the Infectious Disease Society of America focus on vancomycin- and metronidazole-based regimens. [1] Recommendations include metronidazole 500 mg orally three times a day for 10-14 days for initial episode of mild to moderate CDI. vancomycin 125 mg orally four times a day for 10-14 days for initial severe episode of CDI, and vancomycin 500 mg oral (and per rectum, if ileus is present) with or without intravenous metronidazole for severe, complicated infection.

First recurrence episode is treated similarly; second recurrence is usually treated with tapered or pulsed vancomycin regimen. [1] Antimotility agents including narcotics and loperamide should be avoided as they increase the risk of toxic megacolon. [8] Recently, the FDA has approved the use of fidaxomicin for CDI, which has had a lower recurrence rate compared to vancomycin in two studies. [23]

The success of other alternatives to standard treatment including probiotics; toxin-binding agents, and vaccine remains unclear. The use of probiotics is conflicting, [24],[25],[26] Saccharomyces boulardii has been found to decrease the recurrence rate of CDI by 30-33% when is used with antibiotics. [26] Toxin-binding agents such as tolevamer was also found to reduce the recurrence of CDI by 20-24% compared to standard antibiotics, however, it was not as effective as metronidazole or vancomycin in treating the primary episode of CDI (46% vs. 76-81%, respectively). [27],[28]

  Fecal Microbiota Transplantation Top

The major problem in treating CDI is the high recurrence rate; the emergence of new resistant strains has also complicated matters more. [18],[29],[30] Recurrent CDI has been estimated to be 15-30% after the initial episode and reaches 65% after subsequent ones. [31] Recurrent CDI is typically treated with tapered vancomycin dose with 31% recurrence rate or pulsed regimen of metronidazole and vancomycin with a recurrence rate of 14%. [32],[33] Given this poor success rate, investigations for alternative therapies continued over several decades. [32],[34],[35],[36],[37]

The human gut contains 10 12 microorganisms per gram of stool, which are referred to as gut microbiota. These microbiota play a role in digestion, immune function, energy production, and metabolism. [38] The microbiome varies between individuals. [38] Diet, environment, and genetics influence the gut microbiome. Diets high in protein and animal fats favor Bacteroides and Ruminococcus predominant bacteria, while those high in carbohydrates favor Prevotella predominant ones. [39],[40] The microbiotas of twin siblings are more similar than those of a mother-child pairs, and those are more similar than a stranger pairs. The microbiota starts to grow after birth from the mother's skin, fecal and vaginal flora, and it's hugely affected by mode of delivery and method of feeding. [41],[42] The microbiota changes with age showing higher ratio of Bacteroidetes phyla in infancy and old age, and a smaller ratio in adulthood. [43] Antibiotics, dietary change, and suppression of immunity can compromise the microbiota and predispose host to CDI. [38]

Chang et al., [44] analyzed the fecal microbiota of seven patients with CDI using 16S rDNA sequencing, they found marked reduction of Bacteroidetes phyla and an increased numbers of Proteobacteria and Verrucomicrobia phyla, both are usually minor in noninfected individuals. A 1989 report by Tvede and Rask-Madsen [45] noted an absence of Bacteroides species in patients with recurrent CDI, those deficiencies were reversed after fecal microbiota transplantation (FMT).

The concept of FMT was first reported in 1958 by Eiseman et al., [46] for the treatment of pseudomembranous colitis. Over the following decades, there have been scattered case reports and case series of FMT for CDI as well as other chronic GI diseases. In the past few years, the interest in FMT evolved because of its potential to restore the gut microbiota. A review article in 2011 found 22 reports of FMT, they included 239 patients. Resolution of symptoms was successful in 87% (145/166) of the patients described to have fulminant or refractory CDI. [47] In 2010 and 2011, 11 studies and case reports were done in different centers; the success rate of FMT was very high approaching 92% [Table 1]. [48],[49],[50],[51],[52],[53],[54],[55],[56],[57],[58]
Table 1: List of reported studies in 2010-2011 and their success rate

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Recently, an open-label, randomized-controlled study was published by van Nood et al., [59] in January 2013, it randomized patients with recurrent CDI to receive either vancomycin 500 mg orally four times a day for 4 days followed by bowel lavage and FMT through nasoduodenal tube, a standard vancomycin treatment for 14 days, or a standard vancomycin treatment with bowel lavage at days 4-5. A total of 81% (13/16) of the FMT group had resolution of CDI and 94% (15/16) after a different donor was used for the remaining three patients. A total of 31% of patients receiving vancomycin alone and 23% receiving vancomycin and bowel lavage had resolution of their infection.

The exact mechanisms of FMT in the treatment of CDI are unclear but may involve restoring the gut microbiota with the missing components, to generate an environment resistant to CDI. [60] Unlike antibiotics that offer transient antibacterial activity and add to the insult on the stool microbiota, FMT seems to offer prolonged presence of antagonistic activity against CDI.

  Patient Indication Top

FMT is indicated for patients with recurrent or relapsing patients CDI; who had three or more episodes of mild to moderate CDI or who failed 6-8 weeks of tapered vancomycin treatment. It is also indicated in patients who had two or more severe episodes of CDI that required hospitalization. Last FMT is indicated in patients with a moderate or a severe episode of CDI, which did not respond to standard antibiotic treatment at 1 week and 48 h, respectively. [61]

  Donor Selection Top

Typical donors are household members or a relative as there is some theoretical belief that they share close microbiota due to common environmental exposures or genetics. No screening guidelines are present at this time, but most donors undergo testing for hepatitis A, B, and C, HIV, syphilis, stool for ova and parasite, CD, Helicobacter pylori, stool culture for enteric pathogens, and stool acid-fast stain for Cyclospora, Isospora, and Cryptosporidium. Donors should not have taken antibiotics in the preceding 3 months, and should not have any chronic GI disease or malignancy. [61] Donors are also excluded if they have any autoimmune diseases, allergic diseases, or metabolic syndrome. [61]

  Recipient Preparation and Administration Top

Various routes of instillation have been described for transplantation of donor's stool. Nasogastric, nasoduodenal, colonoscopic, and retention enema are the most common ones. Samples should be used immediately within 6 h. The volume of the sample varies depending on the route of administration, lower volume with nasogastric route (25-50 mL), where larger volume is used with colonoscopy or enema (250-500 mL). Antidiarrheal agents should be considered after the colonoscopic route, proton pump inhibitors should be used the night before for the nasogastric route. [61]

Many questions are left to answer, whether one route of administration is better than the other, the possible need of antibiotics before the procedure and duration of antibiotic use remain uncertain. The possibility of applying FMT in other chronic GI and non-GI illnesses is an area of investigation. Although the majority of studies focused on recurrent CDI, Brandt et al., [62] advocated the use of FMT as a primary treatment for CDI, as it is safe, superior, and less costly than antibiotic use.

  Conclusion Top

CDI and its complications are on the rise; it is the leading cause of antibiotic and health care-related diarrhea. Traditional antibiotic treatments are becoming less effective with the emergence of new and more virulent strains. CDI recurrence is high even after successful initial response to antibiotics. Probiotics and other new medications such as toxin-binding agents have been tried with unsatisfactory results. FMT has been gaining acceptance recently, as several case reports have shown encouraging results with eradication of CDI, reduction in the recurrence rate, low cost, and very few side effects. A recent open-label randomized-controlled study supported the use of FMT in treatment of refractory and recurrent CDI. [59]

  References Top

1.Cohen SH, Gerding DN, Johnson S, Kelly CP, Loo VG, McDonald LC, et al. Society for Healthcare Epidemiology of America. Infectious Diseases Society of America. Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the society for healthcare epidemiology of America (SHEA) and the infectious disease society of America (IDSA). Infect Control Hosp Epidemiol 2010;5:431-55.  Back to cited text no. 1
2.O′Brien JA, Lahue BJ, Caro JJ, Davidson DM. The emerging infectious challenge of clostridium difficile-associated disease in Massachusetts′s hospitals: Clinical and economic consequences. Infect Control Hosp Epidemiol 2007;28:1219-27.  Back to cited text no. 2
3.Ricciardi R, Rothenberger DA, Madoff RD, Baxter NH. Increasing prevalence and severity of clostridium difficile colitis in hospitalized patients in the United States. Arch Surg 2007;142:624-31.  Back to cited text no. 3
4.Kelly CP, LaMont JT. Clostridium difficile-more difficult than ever. N Eng J Med 2008;359:1932-40.  Back to cited text no. 4
5.Gravel D, Gardam M, Taylor G, Miller M, Simor A, McGeer A, et al. Canadian nosocomial infection surveillance program. Infection control practices related to clostridium difficile infection in acute care hospitals in Canada. Am J Infect Control 2009;37:9-14.  Back to cited text no. 5
6.Rupnik M, Wilcox MH, Gerding DN. Clostridium difficile infection: New developments in epidemiology and pathogenesis. Nat Rev Microbiol 2009;7:526-36.  Back to cited text no. 6
7.Schroeder MS. Clostridium difficile-associated diarrhea. Am Fam Physician 2005;71:921-8.  Back to cited text no. 7
8.Pepin J, Saheb N, Coulombe MA, Alary ME, Corriveau MP, Athier S, et al. Emergence of fluoroquinolones as the predominant risk factor for clostridium difficile-associted diarrhea: A cohort study during an epidemic in Quebec. Clin Infect Dis 2005;41:1254-60.  Back to cited text no. 8
9.Gaynes R, Rimland D, Killum E, Lowery HK, Johnson TM 2 nd , Killgore G, et al. Outbreak of clostridium difficile infection in a long-term facility: Association with galifloxacin use. Clin Infect Dis 2004;38:640-5.  Back to cited text no. 9
10.Loo VG, Poirier L, Miller MA, Oughton M, Libman MD, Michaud S, et al. A predominantly clonal multi-institutional out break of clostridium difficile-associated diarrhea with high morbidity and mortality. N Eng J Med 2005;353:2442-9.  Back to cited text no. 10
11.Bignardi GE. Risk factors for clostridium difficile infection. J Hosp Infect 1998;40:1-15.  Back to cited text no. 11
12.Arango JI, Restrepo A, Schneider DL, Callander NS, Ochoa-Bayona JL, Restrepo MI, et al. Incidence of Clostridium difficile-associated diarrhea before and after autologous peripheral blood stem cell transplantations for lymphoma and multiple myeloma. Bone Marrow Transplant 2006;37:517-21.  Back to cited text no. 12
13.Carter GP, Rood JI, Lyras D. The role of toxin A and B in clostridium difficile-associated disease: Past and present prospectives. Gut Microbes 2010;1:58-64.  Back to cited text no. 13
14.Rodemann JF, Dubberke ER, Reske KA, Seo da H, Stone CD. Incidence of clostridium difficile infection in inflammatory bowel disease. Clin Gastroenterol Hepatol 2007;5:339-44.  Back to cited text no. 14
15.Health Canada. C. difficile (clostridium difficile). (Accessed January 17, 2013, at http://www.hc-sc.gc.ca/hl-vs/iyh-vsv/diseases-maladies/cdifficle-eng.php).   Back to cited text no. 15
16.Public Health Agency of Canada. Fact sheet-Clostridium difficle (C.difficile). (Accessed January 17, 2013, at http://phac-aspc.gc.ca/id-mi/cdiff-eng.php).   Back to cited text no. 16
17.Calfee DP. Clostridium difficle: A reemerging pathogen. Geriatrics 2008;63:10-21.  Back to cited text no. 17
18.Bartlett JG. Narrative review: The new epidemic of Clostridium difficile-associated enteric disease. Ann Intern Med 2006;145:758-64.  Back to cited text no. 18
19.Dallal RM, Harbrecht BG, Boujoukas AJ, Sirio CA, Farkas LM, Lee KK, et al. Fulminant Clostridium difficile: An underappreciated and increasing cause of death and complications. Ann Surg 2002;235:363-72.  Back to cited text no. 19
20.Adams SD, Mercer DW. Fulminant Clostridium difficile colitis. Curr Opin Crit Care 2007;13:450-5.  Back to cited text no. 20
21.Musher DM, Aslam S. Treatment of Clostridium difficile colitis in the critical care setting. Crit Care Clin 2008;24:279-91.  Back to cited text no. 21
22.Sailhamer EA, Carson K, Chang Y, Zacharias N, Spaniolas K, Tabbara M, et al. Fulminant Clostridium difficile colitis: Patterns of care and predictors of mortality. Arch Surg 2009;144:433-9.  Back to cited text no. 22
23.Gerding DN, Johnson S. Management of Clostridium difficile infection: Thinking inside and outside the box. Clin Infec Dis 2010;51:1306-13.  Back to cited text no. 23
24.Imhoff A, Karpa K. Is there a future for probiotics in preventing Clostridium difficile-associated disease and treatment of recurrent episodes? Nutr Clin Pract 2009;24:15-32.  Back to cited text no. 24
25.Rhode CL, Bartolini V, Jones N. The use of probiotics in the prevention and treatment of antibiotic-associated diarrhea with special interest in Clostridium difficile-associated diarrhea. Nutr Clin Pract 2009;24:33-40.  Back to cited text no. 25
26.McFarland LV, Surawicz CM, Greenberg RN, Fekety R, Elmer GW, Moyer KA, et al. A randomized placebo-controlled trail of Saccharomyces boulardii in combination with standard antibiotics for Clostridium difficile disease. JAMA 1994;271:1913-8.  Back to cited text no. 26
27.Weiss K. Toxin-binding treatment for Clostridium difficile: A review including reports of studies with tolevamer. Int J Antimicrob Agents 2009;33:4-7.  Back to cited text no. 27
28.Mattila E, Anttila VJ, Broas M, Marttila H, Poukka P, Kuusisto K, et al. A randomized, double-blind study comparing Clostridium difficle immune whey and metronidazole for recurrent Clostridium difficle-associated diarrhea: Efficacy and safety data of a prematurely interrupted trial. Scand J Infect Dis 2008;40:702-8.  Back to cited text no. 28
29.Bauer MP, Kuijper EJ, van Dissel JT. European Society of Clinical Microbiology and Infectious Diseases. European Society of Clinical Microbiology and Infectious Diseases (ESCMID): Treatment guidance for Clostridium difficile infection (CDI). Clin Microbiol Infect 2009;15:1067-79.  Back to cited text no. 29
30.Johnson S. Recurrent Clostridium difficile infection: A review of risk factors, treatments, and outcomes. J Infect 2009;58:403-10.  Back to cited text no. 30
31.McFarland LV, Elmer GW, Surawicz CM. Breaking the cycle: Treatment strategies for 163 cases of recurrent Clostridium difficle disease. Am J Gastrenterol 2002;97:1769-75.  Back to cited text no. 31
32.Surawicz CM. Treatment of recurrent Clostridium difficile-associated disease. Nat Clin Pract Gastroenterol Hepatol 2004;1:32-8.  Back to cited text no. 32
33.Huebner ES, Surawicz CM. Treatment of recurrent Clostridium difficile diarrhea. Gastroenterol Hepatol (NY) 2006;2:203-8.  Back to cited text no. 33
34.Reid G, Younes JA, Van der Mei HC, Gloor GB, Knight R, Busscher HJ. Microbiota restoration: Natural and supplemented recovery of human microbial communities. Nat Rev Microbiol 2011;9:27-38.  Back to cited text no. 34
35.Hookman P, Barkin JS. Clostridium difficile associated infection, diarrhea and colitis. World J Gastroenterol 2009;15:1554-80.  Back to cited text no. 35
36.Bauer MP, van Dissel JT. Alternative strategies for Clostridium difficile infection. Int J Antimicrob Agents 2009;33:S51-6.  Back to cited text no. 36
37.Louie TJ, Miller MA, Mullane KM, Weiss K, Lentnek A, Golan Y, et al. OPT-80-003 Clinical Study Group. Fidaxomicin versus vancomycin for Clostridium difficile infection. N Engl J Med 2011;364:422-31.  Back to cited text no. 37
38.Arumugam M, Raes J, Pelletier E, Le Paslier D, Yamada T, Mende DR, et al. Enterotypes of the human gut mirobiome. Nature 2011;473:174-80.  Back to cited text no. 38
39.Wu GD, Chen J, Hoffmann C, Bittinger K, Chen YY, Keilbaugh SA, et al. Linking long-term dietary pattern with gut microbial enterotypes. Science 2011;334:105-8.  Back to cited text no. 39
40.Spor A, Koren O, Ley R. Unravelling the effects of the environment and host genotype on the gut microbiome. Nat Rev Microbiol 2011;9:279-90.  Back to cited text no. 40
41.Palmer C, Bik EM, DiGiulio DB Relaman DA, Brown PO. Development of the human infant intestinal microbiota. PLoS Biol 2007;5:e177.  Back to cited text no. 41
42.Marques TM, Wall R, Ross RP, Fitzgerald GF, Ryan CA, Stanton C. Programming infant gut mircobiota: Influence of dietary and environmental factores. Curr Opin Biotechnol 2010;21:149-56.  Back to cited text no. 42
43.Mariat D, Firmesse O, Levenez F, Guimaraes V, Sokol H, Dore J, et al. The Firmictus/Bacteroidetes ratio of the human microbiota changes with age. BMC Microbiol 2009;9:123.  Back to cited text no. 43
44.Chang JY, Antonopoulos DA, Kalra A, Tonelli A, Khalife WT, Schmidt TM, et al. Decreased diversity of the fecal microbiome in recurrent Clostridium difficile-associated diarrhea. J Infect Dis 2008;197:435-8.  Back to cited text no. 44
45.Tvede M, Rask-Madsen J. Bacteriotherapy for chronic relapsing Clostridium difficile diarrhea in six patients. Lancet 1989;1:1156-60.  Back to cited text no. 45
46.Eiseman B, Silen W, Bascom GS, Kauvar AJ. Fecal enema as an adjunct in the treatment of pseudomembranous enterocolitis. Surgery 1958;44:854-9.  Back to cited text no. 46
47.Landy J, AL-Hassi HO, McLaughlin SD, Walker AW, Ciclitira PJ, Nicholls RJ, et al. Review article: Fecal transplantation therapy for gastrointestinal disease. Aliment Pharmacol Ther 2011;34:409-15.  Back to cited text no. 47
48.Arkkila PE, Uusitalo-Seppala R, Lehtola L, Moilanan V, Ristikankare M, Mattila E. Fecal bacteriotherapy for recurrent Clostridium difficile infection. Gastroenterology 2010;138 (Suppl 1):S5.  Back to cited text no. 48
49.Khoruts A, Dicksved J, Jansson JK, Sadowsky MJ. Changes in the composition of human microbiome after bacteriotherapy for recurrent Clostridium difficile-associated diarrhea. J Clin Gastroenterol 2010;44:354-60.  Back to cited text no. 49
50.Yoon SS, Brandt LJ. Treatment of refractory/recurrent C. difficile-associated disease by donated stool transplanted via colonoscopy: A case series of 12 patients. J Clin Gastroenterol 2010;44:562-6.  Back to cited text no. 50
51.Rohlke F, Surawicz CM, Stollman N. Fecal flora reconstitution for recurrent Clostridium difficile infection: Results and methodology. J Clin Gastroenterol 2010;44:567-70.  Back to cited text no. 51
52.Silverman MS, Davis I, Pillai DR. Success of self-administered home fecal transplantation for chronic Clostridium difficile infection. Clin Gastroenterol Hepatol 2010;8:471-3.  Back to cited text no. 52
53.Garborg K, Waagsbo B, Stallemo A, Matre J, Sundoy A. Results of fecal donor instillation therapy for recurrent Clostridium difficile-associated diarrhea. Scand J Infect Dis 2010;42:857-61.  Back to cited text no. 53
54.Russell G, Kaplan J, Ferraro M, Michelow IC. Fecal bacteriotherapy for relapsing Clostridium difficile infection in a child: A proposed treatment protocol. Pediatrics 2010;126:e239-42.  Back to cited text no. 54
55.Kelly C, de Leon L. Successful treatment of recurrent Clostridium difficile infection with donor stool administered at colonoscopy: A case series. Am J Gastroenterol 2010;105 (Suppl 1):S135.  Back to cited text no. 55
56.Mellow M, Kanatzar A. Colonoscopic fecal bateriotherapy in the treatment of recurrent Clostridium difficile infection. Am J Gastroenterol 2010;105(Suppl 1):S135.  Back to cited text no. 56
57.Kassam Z, Hundal R, Marshall JK, Lee CH. Fecal transplantation via retention enemas is effective for recurrent or refractory Clostridium difficile-associated diarrhea. Gastroenterology 2010;138:207-8.  Back to cited text no. 57
58.Kelly C, de Leon L, Jasutkar N. Fecal microbiota transplantation for relapsing Clostridium difficile infection in 26 patients: Methodology and results. J Clin Gastroenterol 2012;46:145-9.  Back to cited text no. 58
59.van Nood E, Vrieze A, Nieuwdrop M, Fuentes S, Zoetendal EG, de Vos WM, et al. Duodenal infusion of donor feces for recurrent Clostridium difficile. N Engl J Med 2013;368:407-15.  Back to cited text no. 59
60.Borody TJ, Warren EF, Leis SM, Surace R, Ashman O, Siarakas S. Bacteriothrapy using fecal flora: Toying with human motions. J Clin Gastroenterol 2004;38:475-83.  Back to cited text no. 60
61.Bakken JS, Borody T, Brandt LJ, Brill JV, Demarco DC, Franzos MA, et al. Fecal microbiota transplantation w orkgroup. Treating Clostridium difficile infection with fecal microbiota transplantation. Clin Gastroenterol Hepatol 2011;12:1044-9.  Back to cited text no. 61
62.Brandt LJ, Borody TJ, Campbell J. Endoscopic fecal microbiota transplantation: "First-line" treatment for severe Clostridium difficile infection? J Clin Gastroenterol 2011;45:655-7.  Back to cited text no. 62


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