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Changes in the Composition of the Human Fecal Microbiome After Bacteriotherapy for Recurrent Clostridium difficile-associated Diarrhea

Khoruts, Alexander MD*; Dicksved, Johan PhD; Jansson, Janet K. PhD; Sadowsky, Michael J. PhD§

Journal of Clinical Gastroenterology: May-June 2010 - Volume 44 - Issue 5 - p 354-360
doi: 10.1097/MCG.0b013e3181c87e02

Clostridium difficile-associated disease (CDAD) is the major known cause of antibiotic-induced diarrhea and colitis, and the disease is thought to result from persistent disruption of commensal gut microbiota. Bacteriotherapy by way of fecal transplantation can be used to treat recurrent CDAD, which is thought to reestablish the normal colonic microflora. However, limitations of conventional microbiologic techniques have, until recently, precluded testing of this idea. In this study, we used terminal-restriction fragment length polymorphism and 16S rRNA gene sequencing approaches to characterize the bacterial composition of the colonic microflora in a patient suffering from recurrent CDAD before and after treatment by fecal transplantation from a healthy donor. Although the patient's residual colonic microbiota, prior to therapy was deficient in members of the bacterial divisions-Firmicutes and Bacteriodetes, transplantation had a dramatic impact on the composition of the patient's gut microbiota. By 14 days posttransplantation, the fecal bacterial composition of the recipient was highly similar to that of the donor and was dominated by Bacteroides spp. strains and an uncharacterized butyrate producing bacterium. The change in bacterial composition was accompanied by resolution of the patient's symptoms. The striking similarity of the recipient's and donor's intestinal microbiota following after bacteriotherapy suggests that the donor's bacteria quickly occupied their requisite niches resulting in restoration of both the structure and function of the microbial communities present.

*Department of Medicine and Center for Immunology, University of Minnesota, Minneapolis

Department of Soil, Water, and Climate, BioTechnology Institute, and Microbial and Plant Genomics Institute, University of Minnesota, St. Paul, MN

Department of Microbiology, Swedish University of Agricultural Sciences, Uppsala, Sweden

§Lawrence Berkeley National Laboratory, Division of Earth Sciences, Berkeley, CA

Supported, in part, by US Department of Energy Contract DE-AC02-05CH11231 with Lawrence Berkeley National Laboratory to JKK and by funding from the University of Minnesota Agricultural Experiment Station to MJS.

Reprints: Michael J. Sadowsky, PhD, University of Minnesota, Department of Soil, Water, and Climate, BioTechnology Institute, 1991 Upper Buford Circle, 439 Borlaug Hall, St. Paul, MN 55108 (e-mail:

Received for publication August 12, 2009

accepted October 28, 2009

Alexander Khoruts and Johan Dicksved contributed equally to this study.

Potential conflicts of interest: All authors no conflicts.

© 2010 Lippincott Williams & Wilkins, Inc.