Fecal Microbiota Transplant for CDI in a Pregnant Patient

Clostridium difficile infection has been associated with negative outcomes in the general population and in pregnant patients. Fecal microbiota transplant has become the standard for treatment of recurrent as well as refractory C. difficile infection. We present a case of a 28-year-old pregnant woman who presented with recurrent C. difficile infection despite treatment with vancomycin and fidaxomicin and underwent a successful fecal microbiota transplant through colonoscopy at 18 weeks of gestation. She no longer required antibiotics for the remainder of her pregnancy to treat C. difficile and had a term vaginal delivery at 39 weeks of gestation. Our pregnant patient tolerated and responded to a fecal microbiota transplant for treatment of recurrent C. difficile infection. Future large-scale studies are needed to determine the efficacy, safety, and long-term effects of manipulating the microbiome in pregnant patients and the neonates.


Summary:


The exact incidence and prevalence of Clostridium difficile infection in pregnant women are unknown but reports of cases associated with significant morbidity raise concern. Up to 30% of patients infected with C. difficile may relapse after the first episode and up to 60% relapse after a second episode. The low adverse event profile and high efficacy rates reaching above 90% for fecal microbiota transplant (FMT) in nonpregnant adults provide support for the expansion of its use.


The patient was a 28-year-old woman who present to the outpatient gastroenterology clinic at 16 weeks of gestation with recurrent C. difficile infection. Her symptoms included up to 12 watery bowel movements a day with nausea, vomiting, and abdominal cramping. The patient’s pregnancy progressed well despite the episodes of C. difficile infection.


There were concerns about the use of long term antibiotics through the patient’s pregnancy including the potential for development of antibiotic resistance. There was also concern about the potential for relapse of C. difficile infection despite being on antibiotics during the pregnancy, which could have led to significant consequences for both the mother and the fetus. Due to these concerns, a colonoscopy with fecal microbiota transplant was performed at 18 weeks of gestation.


The patient reported complete resolution of her symptoms with normal bowel pattern. Her pregnancy proceeded with no further therapy for C. difficile infection. She delivered at 39 weeks of gestation and the infant was developing normally in follow-up visits. The patient had no further recurrence of C. difficile infection.


Read the full paper at: https://www.ncbi.nlm.nih.gov/pubmed/28178052