Treatment approaches including fecal microbiota transplantation for recurrent Clostridium difficile infection (RCDI) among infectious disease physicians

• An electronic survey was conducted among members of the Emerging Infections Network.
• All but 22 of 538 respondents reported caring for patients with relapsing CDI.
• Oral vancomycin (fixed or tapered dosing) was preferred for recurrent CDI.
• 80% of respondents would consider FMT for patients with recurrent CDI.
• Despite reported success of FMT, significant barriers were reported to institutional adoption of FMT.

BackgroundClostridium difficile infection (CDI) was the most common nosocomial infection in the U.S. in 2010. Most cases of CDI respond to a standard course of antibiotics, but recurrent C. difficile infections (RCDI) are increasingly common. Given the lack of randomized clinical trials, it is important to understand how infectious disease physicians are managing RCDI to inform future clinical research.MethodsAn electronic survey was conducted among members of the Emerging Infections Network (EIN) in October 2012. Respondents were asked to answer specific questions about their treatment approaches toward patients with CDI, including fecal microbiota transplantation (FMT).ResultsThe overall response rate was 621/1212 (51%). The vast majority of respondents had cared for small to moderate numbers of patients with CDI over the prior 6 months, and reported recurrence rates were consistent with published data. Preferred treatment regimens for RCDI showed significant variance from recommendations published in national guidelines. Eighty percent (424/527) of the respondents would consider FMT for patients with RCDI, and of 149 who had FMT available at their institution, 107 (72%) had actually treated >1 patient with FMT in the preceding year. However, significant barriers to institutional adoption of FMT remain for many respondents, despite very good success rates with its use.ConclusionsPhysicians who regularly care for patients with CDI use a variety of treatment approaches for treating severe or recurrent CDI cases. The results of our survey demonstrate that FMT is used by a growing number of infectious disease providers as an effective and safe treatment alternative for patients with multiple recurrences of C. difficile infection.