A novel therapeutic approach to Recurrent Clostridium difficile Infection: Feces Infusion by Le Chen https://padlet.com/extradimensionaloracle/w69nkw3x5349qxw7 Topic # 2: The gut microbiota and the Immune System. Selection of Paper: Duodenal Infusion of Donor Feces for Recurrent Clostridium difficile en-us 2022-08-15 04:04:39 UTC 2025-10-21 00:14:37 UTC hello@padlet.com Creator extradimensionaloracle https://padlet.com/extradimensionaloracle/w69nkw3x5349qxw7/wish/2260903348 Student Name: Le Chen
Student Number: 1002640939
IMM350 Infographic Assignment Topic #2]]> 2022-08-15 04:07:25 UTC https://padlet.com/extradimensionaloracle/w69nkw3x5349qxw7/wish/2260903348 Introduction extradimensionaloracle https://padlet.com/extradimensionaloracle/w69nkw3x5349qxw7/wish/2260903656 2022-08-15 04:08:04 UTC https://padlet.com/extradimensionaloracle/w69nkw3x5349qxw7/wish/2260903656 Background: extradimensionaloracle https://padlet.com/extradimensionaloracle/w69nkw3x5349qxw7/wish/2260904399 It is pointed out by existing studies that success rates for recurrent Clostridium difficile (bacteria that causes diarrhea and other gastrointestinal disease1) infection treatment with antibiotic therapy is not satisfactorily high, at only around 60% and will slump in patients with multiple recurrences2. The low success rates are often associated with the increasing progression of antibiotic resistance which accounts for raised survival of pathogen even in the presence of antibiotics3. ]]> 2022-08-15 04:09:45 UTC https://padlet.com/extradimensionaloracle/w69nkw3x5349qxw7/wish/2260904399 Rationale & Hypothesis: extradimensionaloracle https://padlet.com/extradimensionaloracle/w69nkw3x5349qxw7/wish/2260904611 As the success rates for antibiotic therapy was low, this study was conducted in order to find out a more capable therapeutic strategy in treating recurrent Clostridium difficile infection. The tested therapeutic strategy was selected to be the infusion of donor feces2.
Although not explicitly stated, the hypothesis of this study was that the duodenal infusion of donor feces is more effective in treating recurrent Clostridium difficile infection compared to the use of antibiotics2 (vancomycin). 
]]> 2022-08-15 04:10:13 UTC https://padlet.com/extradimensionaloracle/w69nkw3x5349qxw7/wish/2260904611 Importance: extradimensionaloracle https://padlet.com/extradimensionaloracle/w69nkw3x5349qxw7/wish/2260905126 This study is of great importance because it discovers the potential of achieving higher success rates with a novel therapeutic strategy (the duodenal infusion of donor feces2) in a recurrent Clostridium difficile infection treatment.]]> 2022-08-15 04:11:10 UTC https://padlet.com/extradimensionaloracle/w69nkw3x5349qxw7/wish/2260905126 Feces transplantation extradimensionaloracle https://padlet.com/extradimensionaloracle/w69nkw3x5349qxw7/wish/2260910661 Image Available from: JohnsHopkinsMedicine. Fecal microbial transplantation: A treatment for clostridium difficile. YouTube (2015). Available at: https://www.youtube.com/watch?v=-nDPjGAGEak. (Accessed: 15th August 2022) ]]> 2022-08-15 04:19:36 UTC https://padlet.com/extradimensionaloracle/w69nkw3x5349qxw7/wish/2260910661 Materials & Methods extradimensionaloracle https://padlet.com/extradimensionaloracle/w69nkw3x5349qxw7/wish/2260912132 2022-08-15 04:22:30 UTC https://padlet.com/extradimensionaloracle/w69nkw3x5349qxw7/wish/2260912132 Type of study: extradimensionaloracle https://padlet.com/extradimensionaloracle/w69nkw3x5349qxw7/wish/2260912432 Open-labelled, randomized, controlled trial. ]]> 2022-08-15 04:23:14 UTC https://padlet.com/extradimensionaloracle/w69nkw3x5349qxw7/wish/2260912432 Study population: extradimensionaloracle https://padlet.com/extradimensionaloracle/w69nkw3x5349qxw7/wish/2260912657 Patients recruited in this study were at least 18 years old and had at least 3-month of life expectancy. Eligible patients had a relapse of Clostridium difficile infection after at least one course of antibiotic therapy2.]]> 2022-08-15 04:23:47 UTC https://padlet.com/extradimensionaloracle/w69nkw3x5349qxw7/wish/2260912657 3 Groups of patients: extradimensionaloracle https://padlet.com/extradimensionaloracle/w69nkw3x5349qxw7/wish/2260912890 A total of 43 patients were randomly assigned to one of the following groups2:
1)    (17 patients to) Donor feces infusion, preceded by 4 days of vancomycin regimen and bowel lavage2.
2)    (13 patients to) A standard 14-day vancomycin regimen2.
3)    (13 patients to) A standard 14-day vancomycin regimen with bowel lavage2.
]]> 2022-08-15 04:24:18 UTC https://padlet.com/extradimensionaloracle/w69nkw3x5349qxw7/wish/2260912890 Steps of Donor Feces Infusion: extradimensionaloracle https://padlet.com/extradimensionaloracle/w69nkw3x5349qxw7/wish/2260913216 1.     Selection of donors: Eligible donors were volunteers who passed the screening for transmissible diseases and must be under sixty years old2.
2.     Preparation of donor feces solution: Feces were collected and transported to the hospital on the day of infusion2.
3.     Preparation of the patient prior to infusion: Before the infusion of donor feces, patients were required to take vancomycin for 4 or 5 days2.
4.     Infusion of donor feces solution: The donor feces solution was infused with a 50-cc syringe through the nasoduodenal tube2.
]]> 2022-08-15 04:24:57 UTC https://padlet.com/extradimensionaloracle/w69nkw3x5349qxw7/wish/2260913216 Recurrent Clostridium difficile Infection extradimensionaloracle https://padlet.com/extradimensionaloracle/w69nkw3x5349qxw7/wish/2260917574 Image from: J;, C. C. H. P. D. S. F. Microbiologic factors affecting clostridium difficile recurrence. Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases Available at: https://pubmed.ncbi.nlm.nih.gov/29208562/. (Accessed: 15th August 2022) ]]> 2022-08-15 04:33:17 UTC https://padlet.com/extradimensionaloracle/w69nkw3x5349qxw7/wish/2260917574 Overview of Findings extradimensionaloracle https://padlet.com/extradimensionaloracle/w69nkw3x5349qxw7/wish/2260919801 2022-08-15 04:37:50 UTC https://padlet.com/extradimensionaloracle/w69nkw3x5349qxw7/wish/2260919801 Study Outcome: extradimensionaloracle https://padlet.com/extradimensionaloracle/w69nkw3x5349qxw7/wish/2260920098 As shown by figure 1 and figure 2, among 16 patients in the fusion group who completed the evaluation, 15 of which were cured (2 were cured in a second infusion), making the rates of cure in this group an impressive 94%2.
On the other hand, only 4 of 13 (31%) patients in the vancomycin-alone group and 3 of 13 (23%) patients in the vancomycin and bowel lavage group were cured2. 
Overall, the cure rates of the infusion rates were 2 times and 3 times higher than that of the vancomycin-alone group and vancomycin and bowel lavage group with a 99.9% confidence interval2.
]]> 2022-08-15 04:38:30 UTC https://padlet.com/extradimensionaloracle/w69nkw3x5349qxw7/wish/2260920098 Adverse Events: extradimensionaloracle https://padlet.com/extradimensionaloracle/w69nkw3x5349qxw7/wish/2260920219 Based on findings from table 2, among 16 patients in the infusion group, 15 of which experienced diarrhea (94%)2. Furthermore, 5 patients experienced cramping (31%) and 3 patients experienced belching (19%)2. Noticeably, all above adverse reactions were gone within 3 hours2. ]]> 2022-08-15 04:38:49 UTC https://padlet.com/extradimensionaloracle/w69nkw3x5349qxw7/wish/2260920219 Fecal Microbiota: extradimensionaloracle https://padlet.com/extradimensionaloracle/w69nkw3x5349qxw7/wish/2260920588 As illustrated by figure 3, index of diversity of fecal microbiota from 9 patients who received evaluation prior to the infusion raised significantly within 2 weeks after infusion, the mean increased from 57 to 1792. The diversity levels among these patients became undistinguishable from that of the donors, indicating that the diversity of fecal microbiota of the patients tended to resemble that of the donors. ]]> 2022-08-15 04:39:44 UTC https://padlet.com/extradimensionaloracle/w69nkw3x5349qxw7/wish/2260920588 Figure 1 extradimensionaloracle https://padlet.com/extradimensionaloracle/w69nkw3x5349qxw7/wish/2260922841 Image Available from: Nood, E. van et al. Duodenal infusion of donor feces for recurrent clostridium difficile: Nejm. New England Journal of Medicine (2013). Available at: https://www.nejm.org/doi/full/10.1056/nejmoa1205037. (Accessed: 11th August 2022) ]]> 2022-08-15 04:44:31 UTC https://padlet.com/extradimensionaloracle/w69nkw3x5349qxw7/wish/2260922841 Figure 2 extradimensionaloracle https://padlet.com/extradimensionaloracle/w69nkw3x5349qxw7/wish/2260923378 Image Available from: Nood, E. van et al. Duodenal infusion of donor feces for recurrent clostridium difficile: Nejm. New England Journal of Medicine (2013). Available at: https://www.nejm.org/doi/full/10.1056/nejmoa1205037. (Accessed: 11th August 2022) ]]> 2022-08-15 04:45:48 UTC https://padlet.com/extradimensionaloracle/w69nkw3x5349qxw7/wish/2260923378 Table 2 extradimensionaloracle https://padlet.com/extradimensionaloracle/w69nkw3x5349qxw7/wish/2260924468 Image Available from: Nood, E. van et al. Duodenal infusion of donor feces for recurrent clostridium difficile: Nejm. New England Journal of Medicine (2013). Available at: https://www.nejm.org/doi/full/10.1056/nejmoa1205037. (Accessed: 11th August 2022) ]]> 2022-08-15 04:47:55 UTC https://padlet.com/extradimensionaloracle/w69nkw3x5349qxw7/wish/2260924468 Figure 3 extradimensionaloracle https://padlet.com/extradimensionaloracle/w69nkw3x5349qxw7/wish/2260926127 Image Available from: Nood, E. van et al. Duodenal infusion of donor feces for recurrent clostridium difficile: Nejm. New England Journal of Medicine (2013). Available at: https://www.nejm.org/doi/full/10.1056/nejmoa1205037. (Accessed: 11th August 2022) ]]> 2022-08-15 04:50:28 UTC https://padlet.com/extradimensionaloracle/w69nkw3x5349qxw7/wish/2260926127 Discussion/Conclusion: extradimensionaloracle https://padlet.com/extradimensionaloracle/w69nkw3x5349qxw7/wish/2260927303 2022-08-15 04:53:09 UTC https://padlet.com/extradimensionaloracle/w69nkw3x5349qxw7/wish/2260927303 Major Conclusion: extradimensionaloracle https://padlet.com/extradimensionaloracle/w69nkw3x5349qxw7/wish/2260927793 The implicit hypothesis that the duodenal infusion of donor feces is more effective in treating recurrent Clostridium difficile infection compared to the use of antibiotics2 (vancomycin) was proved to be true by this set of experiments. The efficacy of this therapeutic approach is even better in patients with multiple relapses of infection2.]]> 2022-08-15 04:54:13 UTC https://padlet.com/extradimensionaloracle/w69nkw3x5349qxw7/wish/2260927793 Comparing with recent studies: extradimensionaloracle https://padlet.com/extradimensionaloracle/w69nkw3x5349qxw7/wish/2261582425 Comparing with a more recent study6 which examined the efficacy of fecal microbiota transplantation with a similar but enhanced set of experimental design, not only a secondary outcome (occurrence of severe adverse symptoms) was missing from this study, but also the other study included a much bigger sample size with over 500 patients. Larger sample size could help minimize the bias.   ]]> 2022-08-15 21:13:31 UTC https://padlet.com/extradimensionaloracle/w69nkw3x5349qxw7/wish/2261582425 Sources of error: extradimensionaloracle https://padlet.com/extradimensionaloracle/w69nkw3x5349qxw7/wish/2261582735 A major source of error arises from the small sample size in this trial. As only 43 patients were involved, the results could be highly biased. As the author claimed, the efficacy of the antibiotics was much lower than expected2 which could have led to a biased result. Thus, more trials with larger sample size must be conducted in order to further justify the findings.]]> 2022-08-15 21:14:05 UTC https://padlet.com/extradimensionaloracle/w69nkw3x5349qxw7/wish/2261582735 Impacts & Implication of findings: extradimensionaloracle https://padlet.com/extradimensionaloracle/w69nkw3x5349qxw7/wish/2261582977  In spite of the small sample size, this study laid solid foundation for the therapeutic approach of feces infusion to be applied to the treatment of recurrent Clostridium difficile infection. A recent article7 which claims that the feces infusion has now become the standard treatment method for recurrent Clostridium difficile infection further confirms the findings from this study. The next step of the study is to find out the mechanism under which the feces infusion works much more efficiently in recurrent Clostridium difficile infection compared to use of antibiotics. ]]> 2022-08-15 21:14:35 UTC https://padlet.com/extradimensionaloracle/w69nkw3x5349qxw7/wish/2261582977 Reference: extradimensionaloracle https://padlet.com/extradimensionaloracle/w69nkw3x5349qxw7/wish/2261583565 1.     Canada, P. H. A. of. Government of Canada. Canada.ca (2014). Available at: https://www.canada.ca/en/public-health/services/infectious-diseases/fact-sheet-clostridium-difficile-difficile.html. (Accessed: 12th August 2022) 
2.     Nood, E. van et al. Duodenal infusion of donor feces for recurrent clostridium difficile: Nejm. New England Journal of Medicine (2013). Available at: https://www.nejm.org/doi/full/10.1056/nejmoa1205037. (Accessed: 11th August 2022) 

3.     F;, S. P. M. P. B. Antibiotic resistances of clostridium difficile. Advances in experimental medicine and biology Available at: https://pubmed.ncbi.nlm.nih.gov/29383668/. (Accessed: 12th August 2022) 
4.     JohnsHopkinsMedicine. Fecal microbial transplantation: A treatment for clostridium difficile. YouTube (2015). Available at: https://www.youtube.com/watch?v=-nDPjGAGEak. (Accessed: 15th August 2022) 

5.     J;, C. C. H. P. D. S. F. Microbiologic factors affecting clostridium difficile recurrence. Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases Available at: https://pubmed.ncbi.nlm.nih.gov/29208562/. (Accessed: 15th August 2022) 

6.     Hui, W., Li, T., Liu, W., Zhou, C. & Gao, F. Fecal microbiota transplantation for treatment of recurrent C. difficile infection: An updated randomized controlled trial meta-analysis. PLOS ONE (2019). Available at: https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0210016. (Accessed: 15th August 2022) 
7.     Jessica Allegretti, M. D. Stool transplants are now standard of care for recurrent C. difficile infections. Harvard Health(2019). Available at: https://www.health.harvard.edu/blog/stool-transplants-are-now-standard-of-care-for-recurrent-c-difficile-infections-2019050916576. (Accessed: 15th August 2022) 
]]> 2022-08-15 21:15:43 UTC https://padlet.com/extradimensionaloracle/w69nkw3x5349qxw7/wish/2261583565 To Dear Graders: extradimensionaloracle https://padlet.com/extradimensionaloracle/w69nkw3x5349qxw7/wish/2261629451 If the image submission does not show up properly, please visit the following URL for my IMM350 infographic assignment:  https://padlet.com/extradimensionaloracle/w69nkw3x5349qxw7]]> 2022-08-15 22:54:23 UTC https://padlet.com/extradimensionaloracle/w69nkw3x5349qxw7/wish/2261629451