Faecal microbiota transplantation in patients with Clostridium difficile and significant comorbidities as well as in patients with new indications: A case series

Table 1 The results of fecal microbiota transplantation treatments of thirteen patients with different comorbidities and Clostridium difficile infection

	Patient characteristics	Medical history	Post FMT situation	Adverse events in 1 mo
1	A patient with HIV, ulcerative colitis and rCDI	28-year-old male with HIV, antiviral medication and virus undetectable, previous suspicion of ulcerative colitis. Recurrent diarrhoea with C. difficile positivity, slow response to vancomycin.	No further relapses	No
			Two months after diarrhoea recurred at the same time with mild alcohol associated pancreatitis. In colonoscopy final diagnosis of ulcerative colitis was made. C. difficile remained negative.
2	A patient with HIV, alcoholism and rCDI	59-year-old female, depression, continuous heavy smoking and consumption of alcohol. HIV and antiviral therapy. rCDI after antibiotic treatment for respiratory infection.	No further relapses	No
			Diarrheal continued due to exocrine pancreatic insufficiency and excessive alcohol consumption
			5 mo after FMT C. difficile reinfection treated with vancomycin and fidaxomicin
3	A Haemodialysis patient with rCDI #1	60-year-old female, rheumatoid arthritis and in haemodialysis due to amyloidosis. Chronic atrial fibrillation, polypectomies of rectum adenomas. Had Enterococcus sepsis 2012.	No further relapses.	No
			Half a year after FMT Enterococcus faecalis sepsis and an epidural abscess.
4	A Haemodialysis patient with rCDI #2	19-year-old female, haemodialysis due to Goodpasture syndrome complicated with pulmonary haemorrhage. Immunosuppressive therapy.	No further relapses.	No
5	A Haemodialysis patient with rCDI #3	77-year-old male, haemodialysis after renal carcinoma operation, diabetes II and COPD. Pseudomonas septicaemia followed by rCDI.	No further relapses.	One week after hospitalized due to enema and cystitis
			One week after FMT hospitalized due to generalized enema and possible cystitis.
			Two months after FMT hospitalized due to gastroenteritis, faecal clostridium was negative.
6	A Haemodialysis patient with rCDI #4	80-year-old male. Haemodialysis because of chronic glomerulonephritis, type II diabetes, hypertension, epilepsy, AV-block and a pace maker. Staphylococcus aureus septicaemia followed by rCDI.	No further relapses.	No
			Staphylococcus aureus sepsis 5 mo after the FMT.
7	A Haemodialysis patient with rCDI #5	66-year-old male, haemodialysis due to microscopic polyangiitis. Chronic atrial fibrillation.	No further relapses	No
8	A Haemodialysis patient with rCDI #6	79-year-old female. Hypertension, dyslipidaemia, atrophic gastritis. TIA 2004 and 2005, a pace maker due to bifascicular block. Coronary disease. Haemodialysis due to an episode of rhabdomyolysis.	2 wk after FMT reinfection after an antibiotic treatment of cystitis. No further FMT's due to poor general condition.	2 wk after C. difficile reinfection
			Patient died 2 mo after FMT to underlying diseases
9	A Kidney transplant patient with rCDI #1	78-year-old female. Kidney transplant due to polycystic renal disease. Polycystic liver, type II diabetes, hypertension and asthma. Operated for cholecystectomy and hysterectomy. E. coli sepsis and one month after another infectious episode treated with meropenem followed by severe rCDI.	No further relapses	Gastroenteritis 3 d after FMT Hospitalized 12 d after FMT
			3 d after FMT gastroenteritis, Clostridium was not tested. Restarted vancomycin for 2 d.
			12 d after FMT the patient was hospitalized due to infection, CT scan did not reveal the aetiology.
10	A Kidney transplant patient with rCDI #2	61-year-old female. A kidney transplant due to polycystic renal disease. rCDI after clindamycin for dental infection.	No further relapses	No
11	A Liver transplant patient with rCDI	56-year-old female. Liver transplant due to mushroom intoxication, a moderate renal failure.	No further relapses	No
12	A Patient with a liver transplant, renal insufficiency, haemodialysis and rCDI	69-year-old male. Liver transplantation due to alcohol cirrhosis, followed by renal insufficiency and haemodialysis.	No further relapses	No
13	A Patient with chronic lymphatic leukaemia, chronic norovirus infection and rCDI	65-year-old female. Chronic lymphatic leukaemia since 1996. Autologous stem cell transplantation in 2003. Cytostatic interventions from 2009-2011, after which she had prolonged pancytopenia, infections and hypogammaglobinaemia. In summer 2011, she had chronic norovirus infection and recurrent CDI, several vancomycin courses and gammaglobulin infusions. March 2012 FMT	No primary complications	CDI and norovirus related diarrhoea continued.
			Hospitalized 2 wk after FMT due to diarrhoea.
			Both norovirus and Clostridium difficile stayed positive in stool samples.
			Patient died in August 2012, 5 mo after FMT for complications of her haematological disease.

FMT: Fecal microbiota transplantation; HIV: Human immunodeficiency virus; rCDI: Recurrent Clostridium difficile infection; C. difficile: Clostridium difficile; E. coli: Escherichia coli.

Table 2 The results of fecal microbiota transplantation treatments of eight patients with different new indications

	Patient and diagnosis	Age at 1st FMT and gender	Route of administration	Outcome	FMT related complications
1	A carrier of Salmonella #1	17-year-old male	Colonoscopy	Successful eradication of Salmonella	No
2	A carrier of Salmonella #2	52-year-old female	Colonoscopy	Successful eradication of Salmonella	No
3	A patient with TMAU #1	24-year-old male	Gastroscopy	Moderate self-reported benefit up to 6 mo, at 12 mo symptoms had recurred to former severity	No
4	A patient with TMAU #2	49-year-old female	Gastroscopy	No change in self-reported symptom severity	No
5	A patient with SIBO	66-year-old male	Gastroscopy	Self-reported decrease in symptom severity	No
			(treated 3 times using 2 donors)
6	A patient with lymphocytic colitis	21-year-old female	Colonoscopy	Two week decrease in self-reported symptoms, then recurrence of symptoms to former severity	No
7	A carrier of norovirus	32-year-old female	Colonoscopy	No change in self-reported symptom severity, no success in virus eradication	No
8	A carrier of ESBL-producing	31-year-old female	Colonoscopy	Successful eradication of ESBL-producing E. coli	No

FMT: Fecal microbiota transplantation; TMAU: Trimethylaminuria; SIBO: Small intestinal bacterial overgrowth; E. coli: Escherichia coli.