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A Novel Treatment Approach to Treatment-Resistant, Recurrent Clostridium difficile.

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  • 1University of Toledo College of Medicine, Toledo, OH, USA.

Case Reports in Gastroenterology
|January 6, 2023
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Summary

This case study details a patient with recurrent Clostridium difficile infections who found success with an unconventional treatment combining extended fidaxomicin, cholestyramine, and fecal microbiota transplant, leading to sustained remission.

Keywords:
Fecal microbial transplantRecurrent Clostridium difficile infection

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Area of Science:

  • Gastroenterology
  • Infectious Diseases
  • Microbiology

Background:

  • A 36-year-old male experienced chronic, recurrent Clostridium difficile infections (CDI) for two years.
  • Previous treatment attempts with vancomycin, metronidazole, and fidaxomicin were unsuccessful, leading to significant lifestyle impacts.

Observation:

  • Despite initial fidaxomicin treatment and probiotics, CDI persisted, confirmed by serology and CT imaging showing enteritis.
  • The patient's infection demonstrated resistance to standard CDI therapies.

Findings:

  • An unconventional regimen involving a second course of fidaxomicin, followed by fidaxomicin with cholestyramine, and concluding with fecal microbiota transplant (FMT) was implemented.
  • Two weeks post-FMT, CDI serology became negative, and the patient remained recurrence-free during follow-up.

Implications:

  • This case highlights the potential efficacy of combination therapy and FMT for refractory or recurrent CDI.
  • Novel treatment strategies may be necessary for patients with persistent or resistant Clostridium difficile infections.