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Editor's Correspondence |

Fecal Transplant for Clostridium difficile

Neil Stollman, MD; Christina Surawicz, MD
Arch Intern Med. 2012;172(10):825-826. doi:10.1001/archinternmed.2012.1055.
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Kassam and colleagues1 are to be congratulated on their series of patients successfully treated with “fecal transplant” for refractory or recurrent Clostridium difficile–related disease, demonstrating greater than 90% success rates—highly consistent with prior data, including ours.2

The authors appropriately emphasize that the mode of delivery (enemas) is different than many of the published series using colonoscopic installation or nasogastric tube, and while this is noteworthy, we believe there are other elements of this report that bear emphasis as well and perhaps further clarification. First, they report using 2 healthy donors for all their recipients. Most prior reports have used individually identified donors, typically a spouse or other intimate partner or close family member. While potentially safer (in that if an intimate partner has a transmissible illness, the patient has likely already been exposed), this process can take time in terms of identifying and screening the donor. Having prescreened donors “on call” certainly seems more expeditious, a potentially important issue in acute refractory in-patients (compared with chronically recurrent outpatients). We would be interested in hearing more about the timing of screening; for example, are the donors rescreened repeatedly against the possibility of acquiring an intercurrent and potentially transmissible infection between the time of initial screening and donation?

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May 28, 2012
Zain Kassam, MD; John Marshall, MD, FRCPC; Christine H. Lee, MD, FRCPC, FIDSA
Arch Intern Med. 2012;172(10):825-826. doi:10.1001/archinternmed.2012.1413.
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