Clinical Case Database / Category: Patient Management
Relapsing clostridium difficile infection and the curative role of faecal transplant
Publication details
Dr Chinenye Ilozue
Foundation Years Journal, volume 9, issue 5, p.42 (123Doc Education, London, May 2015)
Abstract
This case-based discussion focuses on an elderly patient with multiple comorbidities who had over seven months of relapsing Clostridium difficile infection with diarrhoea. Treatment with all available pharmacological options including intravenous immunoglobulin therapy was unsuccessful. He received a faecal transplant via nasogastric tube to achieve cure after failure of all previous interventions. The case demonstrates the refractory nature of C. difficile infection in high risk populations and presents the important and perhaps underutilised role of faecal transplantation as a relatively low-cost curative intervention. The case highlights the importance of appropriate and targeted antibiotic use in clinical practice considering the high morbidity and mortality associated with severe C. difficile infection.
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Authors
Dr Chinenye Ilozue (Corresponding author)
ST3 Infectious Diseases & General Internal Medicine
South Tees Hospitals NHS Foundation Trust
Friarage Hospital, Northallerton, DL6 1JG
cilozue@nhs.net
References
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2. Wilcox MH. Updated guidance on the management and treatment of Clostridium difficile infection. Public Health England, 2013.
3. Medicines and Healthcare Products Regulatory Agency [24 January 2015]. Available from: https://yellowcard.mhra.gov.uk/.
4. Faecal microbiota transplant for recurrent Clostridium difficile infection. National Institute for Health and Care Excellence, 2014.
5. van Nood E, Vrieze A, Nieuwdorp M, Fuentes S, Zoetendal EG, de Vos WM, et al. Duodenal infusion of donor feces for recurrent Clostridium difficile. The New England journal of medicine. 2013;368(5):407-15.
6. Gough E, Shaikh H, Manges AR. Systematic review of intestinal microbiota transplantation (fecal bacteriotherapy) for recurrent Clostridium difficile infection. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2011;53(10):994-1002.
7. Vyas D, Aekka A, Vyas A. Fecal transplant policy and legislation. World journal of gastroenterology : WJG. 2015;21(1):6-11.
8. Antimicrobial Stewardship: "Start Smart, - Then Focus'. Department of Health Advisory Committee on Antimicrobial Resistance and Healthcare Associated Infection (ARHAI), 2011.
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About the Clinical Cases Database
The Foundation Years Clinical Cases Database is a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.
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