Fecal Microbiota Transplantation in Recurrent or Refractory Clostridium Difficile Colitis
Fecal Microbiota Transplantation in Recurrent or Refractory Clostridium Difficile Colitis
The host gastrointestinal microbiota is significantly influenced by antibiotic treatment
 which might favor Clostridium difficile infection (CDI), a frequent cause of community- and
 hospital-acquired, potentially life-threatening diarrhoea. CDI is followed by recurrence in
 19-35% of patients despite adequate first line antimicrobial therapy. Currently there is no
 standardized therapy of recurrent or refractory CDI, but recent studies show remarkable
 effects of fecal microbiota transplantation (FMT).

 In the current project, we aim to ideally match host and donor for FMT success in recurrent
 or refractory CDI. We will establish a clinical standard operating protocol for FMT, we will
 evaluate its safety and efficacy, and the patient acceptance and quality of life before and
 after FMT. We will analyse persistence of the donor microbiota within the recipient, define
 predictive clinical recipient and donor factors for FMT success and correlate them with
 microbial host and donor metagenomics.

 We hypothesize that our work will yield novel, individualized strategies for recurrent or
 refractory CDI. In perspective, our results may be expanded to treatment of other inflammory
 bowel diseases.
Inclusion Criteria:

 -  recurrent or refractory CDI

 -  previous antimicrobial therapy includes at least on course of vancomycin 4x125 (or
 higher doses) for at least 7d

 -  CDI, defined as: 3 or more loose bowel movements/d AND (presence of C.diff. toxin in
 stools or toxin producing C. diff. strain) OR (endoscopic or histologic evidence of
 pseudomembraneous colitis)

 Exclusion Criteria:

 -  no informed consent

 -  no ability to provide informed consent

 -  immune suppression (continuous immune-suppressive drugs; steroids:
 prednisolone-equivalent > 20 mg for 14d or longer)

 -  lack of appropriate donor

 -  pregnancy