Young female with rheumatic heart disease operated for lapro | Figure 1

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Young female with rheumatic heart disease operated for laproscopic cholecystectomy.

Postoperatively she developed massive swelling of the left hand with blisters over the palmar aspect.

Stool transplantation for treatment of repeated Clostridioides difficile infection

Review question

We reviewed the evidence about the effect of stool transplant compared to currently used treatments such as antibiotics for the treatment of recurrent C difficile diarrhea in adults and children.

What did we find?

We found six clinical trials of 320 adults that met criteria for inclusion in this review that assessed the efficacy and safety of stool transplantation for the treatment of repeated C difficile infection. The time of follow‐up after the treatment with fecal microbiota transplantation (FMT) ranged from eight weeks to 17 weeks. The amount of stool, route of administration, number of administrations, type of donor, and what type of treatment the comparison group received varied among the studies. Five studies excluded people who had weak immune systems (immunocompromised people); one study included people with weak immune systems and apparently normal immune systems (immunocompetent people).

Key results

Stool transplantation probably leads to a larger increase in resolution of repeated infections of C difficile than the other treatments studied. Other treatments included antibiotics such as vancomycin, which are commonly prescribed for this infection. These same studies looked at the rate of serious side effects and risk of death from FMT. Fecal microbiota transplantation likely leads to a small decrease in serious side effects; however, these effects were few. Fecal microbiota transplantation may decrease the risk of death in people with rCDI; however, there were few deaths in either group. Elimination of one study that included some immunocompromised people did not alter these conclusions, but, based on the low number of immunocompromised people enrolled in the included studies, conclusions could not be drawn about the benefits or harms of FMT for rCDI in the immunocompromised population at this time.

Limitations of the evidence:

We judged the overall certainty of the evidence supporting stool transplants as more effective than other treatments for the resolution of repeated C difficile infection as moderate. The certainty of evidence for serious side effects was moderate and the certainty of evidence for deaths was low.

Image description

Axial (images 1 and 2) and coronal (image 3) contrast-enhanced CT of the abdomen show marked circumferential wall thickening of the colon (arrow).

Teaching point

Clostridium difficile is a toxin-producing bacterium that can occur when the normal gut microbiota is disrupted. Bacterial toxins cause mucosal inflammation and edema, which account for the colonic wall thickening seen on imaging. In children, imaging findings are nonspecific and overlap with other causes of infectious or inflammatory colitis. CT is typically reserved for evaluating complications such as toxic megacolon or perforation rather than for primary diagnosis.