Faecal transplantation and infectious diseases practitioners

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

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.

Healthcare-associated infections: new challenges looking for answers

Nosocomial transmission of multiresistant bacteria is a growing healthcare issue. In addition, new pathogens and pathogenic mechanisms, associated with therapies based on the use of live microorganisms, can be of importance in the near future. The current issue of CKJ illustrates healthcare-associated infections that go beyond common bacteria. First, the therapeutic use of live BCG mycobacteria is not without risks in the chronic kidney disease patients. Familiarity with these complications will allow their rapid recognition and optimized management. Second, strict adherence to universal precautions and healthcare guidelines is still mandatory in order to avoid undesirable risks such as transmission of hepatitis B virus.