CLOSTRIDIUM DIFFICILE COLITIS: THE ROLE OF SURGERY AND FECAL MICROBIOTA TRANSPLANT

BACKGROUND. The most challenging task in treating the Clostridium difficile colitis (CDC) is to deal with its fulminant form. It is often nonresponding to antibiotics and, upon recurrence, necessitates surgical treatment. The primary aim of our prospective research was to evaluate surgical treatment results in patients with severe CDC in the period of 2008-2014, determining risk factors leading to serious postoperative morbidity and mortality. Our secondary objective was to assess the success of faecal microbiota transplant (FMT) treatment of the recurrent colitis caused by Clostridium difficile in the period of2010-2014. METHODS. During 2008-2014, Clostridial toxins were detected in 1956 patients at the University Hospital Brno. From them, 37 patients underwent surgery for a severe form of colitis. The Fisher exact test and Mann-Whitney test were used to evaluate factors affecting increased mortality and incidence of serious postoperative complications. Factors affecting overall survival were assessed using the Log-rank test. From 2010 to 2014, there were 80 patients with CDC recurrence enrolled and treated with FMT at the Department of Infectious RESULTS. Factors that were proven statistically significant to increase the mortality and incidence of serious postoperative complications included: Mental status changes before the surgery (p=0,008), the albumin level on the day of surgery ≤20 g/l (p=0,005) and the total serum proteins level on the day of surgery ≤45 g/l (p=0,037). Statistically significant factors negatively affecting overall survival were found to be these: circulatory instability before surgery (p-value=0,035), mental status changes or artificial lung ventilation with pharmacological attenuation of consciousness before surgery (p=0,025), CRP value on the day of surgery >75 mg/l (p=0,034), the albumin level on the day of surgery ≤18,5 g/l (p=0,007), blood urea on the day of surgery >10 mmol/l (p=0,019) and the serum creatinine on the day of surgery >120 ymol/l (p-value=0,004). Thirty-day mortality reached nearly 35%, morbidity climbed up to 89%, and the 90-day mortality was 54°%. A total of 80 patients were treated for recurrent CDC with FMT and the success rate of the method was 83,1%. CONCLUSION. Early and accurate surgical intervention in the fulminant form of CDC improves significantly prognosis of patients. FMT is an effective and safe methodfor treatment of the recurrent form of Clostridium colitis.

Clostridium difficile colitis, toxic colitis, surgery, colectomy, fecal microbiota transplant, Clostridium difficile ассоциированный колит

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