Stool substitute transplant therapy for the eradication of Clostridium difficile infection: ‘RePOOPulating’ the gutReport as inadecuate

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, 1:3

First Online: 09 January 2013Received: 20 March 2012Accepted: 18 July 2012


BackgroundFecal bacteriotherapy ‘stool transplant’ can be effective in treating recurrent Clostridium difficile infection, but concerns of donor infection transmission and patient acceptance limit its use. Here we describe the use of a stool substitute preparation, made from purified intestinal bacterial cultures derived from a single healthy donor, to treat recurrent C. difficile infection that had failed repeated standard antibiotics. Thirty-three isolates were recovered from a healthy donor stool sample. Two patients who had failed at least three courses of metronidazole or vancomycin underwent colonoscopy and the mixture was infused throughout the right and mid colon. Pre-treatment and post-treatment stool samples were analyzed by 16 S rRNA gene sequencing using the Ion Torrent platform.

ResultsBoth patients were infected with the hyper virulent C. difficile strain, ribotype 078. Following stool substitute treatment, each patient reverted to their normal bowel pattern within 2 to 3 days and remained symptom-free at 6 months. The analysis demonstrated that rRNA sequences found in the stool substitute were rare in the pre-treatment stool samples but constituted over 25% of the sequences up to 6 months after treatment.

ConclusionThis proof-of-principle study demonstrates that a stool substitute mixture comprising a multi-species community of bacteria is capable of curing antibiotic-resistant C. difficile colitis. This benefit correlates with major changes in stool microbial profile and these changes reflect isolates from the synthetic mixture.

Trial registrationClinical trial registration number: NCT01372943

KeywordsClostridium difficile Fecal bacteriotherapy Probiotics Gut microbiome AbbreviationsCDIClostridium difficile infection

gDNAgenomic DNA

OTUOperational taxonomic unit

PCRPolymerase chain reaction

QIIMEQuantitative Insights Into Microbial Ecology

V6 rRNAVariable region 6 of the 16S ribosomal RNA gene.

Electronic supplementary materialThe online version of this article doi:10.1186-2049-2618-1-3 contains supplementary material, which is available to authorized users.

Elaine O Petrof, Gregory B Gloor contributed equally to this work.

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Author: Elaine O Petrof - Gregory B Gloor - Stephen J Vanner - Scott J Weese - David Carter - Michelle C Daigneault - Eric M 


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