Mention fecal transplants to anyone and you’ll likely be met with the same reaction. “Why would anyone do that?” But for thousands of people suffering from deadly C. difficile, also known as C. diff, infections, this lifesaving procedure is worth the "ick" factor.
C. diff is a spore-producing type of bacteria found throughout the environment. Anyone can become infected with C. diff, but those who have been recently treated with antibiotics are most vulnerable. When antibiotics fight off harmful bacteria, they also destroy the healthy bacteria that protect the body against infection, leaving the body susceptible to C. diff. Once a C. diff infection is established, the bacteria release toxins that attack the lining of the intestine and produce mild-to-severe symptoms such as:
- Abdominal pain.
Doctors have traditionally treated C. diff with antibiotics, but spores can be resistant to antibiotic treatment, leaving the patient vulnerable to reinfection. Antibiotics are only 60 percent effective in eliminating an initial infection and antibiotic effectiveness drops with each recurring infection (Source: Mayo Clinic).
Recently, fecal microbiota transplantation (FMT) has gained popularity as an alternative treatment for C. diff that is extremely effective. FMT is the process of reintroducing a healthy diversity of bacteria into a patient’s gastrointestinal tract through healthy donor stool. Patients choose a donor, who can be anyone from a friend or family member to a complete stranger, and the donor is screened for blood-borne diseases such as HIV, syphilis and hepatitis. The stool is also thoroughly screened for the presence of parasites (C. difficile, Giardia, Cryptosporidium, Isospora and norovirus). Once stool is determined to be healthy, it is suspended in saline and administered into the patient’s colon or small intestine through a colonoscope.
Colleen Kelly, M.D., clinical assistant professor of medicine at Brown University, in Providence, R.I., reports a definite increase in FMT being offered to treat C. diff infections. She partially credits this increase to a 2013 study published in the New England Journal of Medicine that found that 82 percent of patients with C. diff infections responded to FMT, compared with just 31 percent of those who responded to the antibiotic vancomycin.
Kelly also considers the FDA’s decision to ease up on their restrictions regarding FMT to be a significant factor. The FDA previously required all doctors performing FMT to receive investigational new drug permission, but in 2013 the agency enacted a policy of enforcement discretion which allows practitioners to perform FMT as long as they give the patient informed consent.
Lawrence J. Brandt, M.D., professor of medicine and surgery at Albert Einstein College of Medicine and emeritus chief of the Division of Gastroenterology at Montefiore Medical Center in New York City, is another proponent of FMT who is pleased with recent developments.
“The rationale is that we can avoid another course of the anti-C. difficile antibiotics that, for example, in the case of vancomycin, is really maintaining the condition for which you were given it in the first place: a disturbance in the microbiota, or dysbiosis. FMT can immediately re-establish the normal diversity of the intestinal microbiome and thus restore the ability of the microbiota to resist colonization” (Source: Gastroenterology & Endoscopy News).